Non-Melanoma Skin Cancers Coverage from Every Angle

Serial Excision: Appropriate Alternative to Mohs Micrographic Surgery for Non-Melanoma Skin Cancer?

By: Vanessa A. Carter, BS
Posted: Thursday, July 22, 2021

Although Mohs micrographic surgery is the most common procedure for non-melanoma skin cancer excision, Stephen B. Baker, MD, DDS, of MedStar Georgetown University Hospital, Washington, DC, and colleagues aimed to explore the outcomes of serial excision as a possible alternative removal method. Published in Plastic and Reconstructive Surgery Global Open, their results suggested that serial excision is not only effective, but it may even be performed at a lower cost than Mohs surgery, with consistent results.

“The incidence of non-melanoma skin cancer is expected to rise as the American population continues to age,” the researchers mentioned. “This study highlights the critical importance of reevaluating the select indications of Mohs micrographic surgery to ensure the most judicious allocation of health-care resources.”

The investigators retrospectively reviewed 129 patients who had a total of 205 basal cell or squamous cell carcinoma lesions. Lesion characteristics, patient demographics, and excision characteristics were recorded to determine the number of excisions necessary to reach negative margins.

Among the patient population, 79 were women and 50 were men, with most identifying as White (91.5%). The mean patient age at the first lesion presentation was 64 years. Basal cell carcinoma, squamous cell carcinoma, squamous cell carcinoma in situ, and combined basal cell/squamous cell carcinoma were identified in 64.4%, 22.4%, 11.7%, and 1.5% of participants, respectively.

Lesions were located at similar rates across low-risk (38.5%), high-risk (33.7%), and medium-risk (27.8%) areas. Notably, all lesions that required Mohs micrographic surgery (n = 12) were in high-risk areas.

Finally, the investigators reported that serial excision may offer a financial benefit when compared with Mohs micrographic surgery. Consistent with the findings of other published studies, Mohs micrographic surgery was found to be more expensive than serial excision while offering a marginally improved recurrence rate. “Mohs micrographic surgery should be reserved for clinical scenarios in which its superior effectiveness has been clearly proved,” the investigators suggested.

Disclosure: The study authors reported no conflicts of interest.

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