Mohs Surgery for Non-melanoma Facial Skin Cancers

Skin cancers are the most common malignancies occurring in the Caucasian population. Basal cell carcinoma (BCC) represents 75% and squamous cell carcinoma (SCC) 20% of cutaneous malignancies5,29. The other 5%, including melanomas, are beyond the scope of this article. Over the last decade, a significant rise in incidence of non melanoma skin cancer (NMSC) has been noted16,20,29. However, the mortality rates have decreased over the last few decades, attesting to the effectiveness of increased public awareness including sun protection as well as improved physician knowledge and enhanced, more accessible therapy29. There are several methods of therapy for NMSC’s including radiotherapy, cryotherapy, curettage/electrodessication, conventional excision and Mohs micrographic surgery. Radiotherapy, cryotherapy, curettage/electrodessication are modes of field therapy heavily reliant on visual assessment of margins and without pathological control of complete removal. Conventional excision is often followed by limited pathological checking of margins54. This contrasts with Mohs micrographic surgery described in detail below, which aims to assess 100% of the peripheral and deep margins of the specimen. It is well established that conventional treatment modalities generally result in high cure rates for small circumscript primary tumours with well-defined borders. However, a comprehensive review of relevant studies over 4 decades demonstrates that the highest overall cure rate for primary as well as recurrent NMSC is achieved by Mohs cutaneous micrographic surgery (Table 1)63,64. These favourable cure rates using the modality of Mohs surgery are supported by the author’s 9 year experience and are the reasons for highlighting this technique in the current review.