Mohs Micrographic Surgery for Basal Cell Carcinoma: Predictive Factors for Increased Stages and Relative Defect Sizes

Area of Science:

• Dermatology
• Surgical Oncology
• Oncology

Background:

• Basal cell carcinoma (BCC) is the most common cancer in Australia, with Mohs micrographic surgery (MMS) being the standard treatment.
• MMS can be resource-intensive, especially for complex cases requiring multiple stages.
• Predicting factors for increased MMS stages and tumor-to-defect size discrepancy is crucial for optimizing treatment.

Purpose of the Study:

• To identify predictors of increased MMS stages in head and neck BCC.
• To determine factors associated with a greater tumor-to-defect size discrepancy.
• To enhance surgical planning and patient outcomes for BCC treatment.

Main Methods:

• Retrospective analysis of 18,346 BCC cases from the Mohs Electronic Database (October 2012 - December 2022).
• Inclusion of patient age, sex, tumor characteristics, and Mohs specialist factors as covariates.
• Analysis of main outcomes: number of MMS stages and relative defect size.

Main Results:

• Older patients and larger tumors required more MMS stages and had larger relative defect sizes.
• Nodular BCC required fewer stages and had smaller defects, while superficial BCCs required similar stages to aggressive subtypes.
• Tumors on the ear, eye, and nose required more stages; increased Mohs specialist experience reduced stages and defect sizes.

Conclusions:

• Patient age, tumor size, subtype, cosmetic unit, and Mohs specialist experience significantly influence MMS stages and defect sizes in head and neck BCC.
• Recognizing these predictive factors can optimize surgical planning and personalize treatment strategies.
• This understanding can lead to improved patient outcomes in BCC management.