Mohs Surgery vs Wide Local Excision in cSCC

By: JNCCN 360 Staff
Posted: Monday, April 28, 2025

Patients with high-stage cutaneous squamous cell carcinoma (cSCC) have an increased risk of recurrence, metastasis, and mortality—which Mohs surgery may be able to lower more effectively than wide local excision, according to findings from a recent study published in JAMA Dermatology. The retrospective cohort study, conducted by Chrysalyne D. Schmults, MD, MSCE, of Brigham and Women's Hospital, Boston, Massachusetts and colleagues, compared local recurrence, nodal metastasis, distant metastasis, any recurrence, and disease-specific death in patients who were treated with wide local excision to those treated with Mohs surgery.

The study consisted of 216 patients with primary high-stage cutaneous squamous cell carcinoma,cSCC with a median age of 73.5. Eighty-five 85 patients were treatedunderwent with wide local excision, and 131 witunderwenth Mohs surgery. Of these, 19 patients who received wide local excision required re-excision and 16 later underwent Mohs surgery, while 3 who underwent Mohs surgery later received wide local excision. The study authors found that “the rate of developing all adverse outcomes was greater for wide local excision compared with Mohs surgery.” This included in both the crude cause-specific hazard models , and the inverse probability of treatment weighting hazard models.

In the wide local excision group, 19.8% of patients experienced local recurrence, compared to 9.6% in the Mohs surgery group; nodal metastasis rates were 17.9% vs 11.0%, distant metastasis rates were 8.4% vs 4.4%, 32.0% vs 15.8% of patients experienced any recurrence, and 17.5% vs 7.1% experienced disease-specific death.

“The findings affirm the importance of complete margin assessment via Mohs surgery or alternative methods of peripheral and deep en face margin assessmentPDEMA according to NCCN Gguidelines,” the study authors concluded. Theyd, and added that patients with primary high-stage cutaneous squamous cell carcinomacSCC should be “should be offered first-line treatment with Mohs surgery whenever possible.”