Patient Indications for Mohs Micrographic Surgery: A Systematic Review

Area of Science:

• Dermatology
• Surgical Oncology
• Evidence-Based Medicine

Background:

• Skin cancer treatment relies on surgery or radiation, but optimal indications for advanced techniques like Mohs micrographic surgery (MMS) require clear evidence.
• Evaluating the efficacy and safety of MMS across diverse skin cancer types and presentations is crucial for clinical decision-making.

Purpose of the Study:

• To systematically review and describe evidence-based indications for Mohs micrographic surgery (MMS) in patients diagnosed with skin cancer.
• To synthesize data on recurrence rates, cure rates, complications, cosmesis, and quality of life associated with MMS.

Main Methods:

• Systematic literature search of MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews (1970-2017).
• Inclusion of randomized controlled trials (RCTs), comparative studies (>30 patients), and single-arm retrospective studies with multivariate analyses.
• Extraction of data on clinical outcomes including recurrence, cure, complications, cosmesis, and quality of life.

Main Results:

• Mohs micrographic surgery (MMS) is recommended for histologically confirmed recurrent basal cell carcinoma (BCC) of the face.
• MMS is appropriate for primary facial BCCs that are larger than 1 cm, exhibit aggressive histology, or are located in the H zone.
• Evidence for non-BCC skin cancers is limited, necessitating case-by-case consideration for MMS.

Conclusions:

• Standard surgical or radiation therapy remains the benchmark for skin cancer treatment due to a lack of high-quality comparative evidence for alternative methods.
• Mohs micrographic surgery (MMS) offers specific, evidence-based indications for certain facial basal cell carcinomas (BCCs).
• Further research is needed to generalize MMS indications to a broader spectrum of skin cancers and patient populations.