Photodynamic therapy in conjunction with Mohs micrographic surgery for basal cell carcinoma: A scenario-based review

Basal cell carcinoma (BCC) is the most common skin cancer. Mohs micrographic surgery (MMS) offers the highest cure rates for high-risk or recurrent BCC, while photodynamic therapy (PDT) is effective for superficial and select nodular BCC. Reports describing their combined use are limited and heterogeneous.

To summarize clinical scenarios in which PDT has been used in conjunction with MMS for BCC and describe reported oncologic and cosmetic outcomes.

A systematic search of PubMed, Embase, and Scopus was performed to identify English-language studies reporting PDT with MMS for BCC. Eligible studies included patients treated with PDT before, during, or after MMS. Data extracted included tumor characteristics, PDT protocol, timing relative to MMS, outcomes, and adverse events. Due to substantial heterogeneity, results were narratively synthesized by clinical scenario.

Eight studies met inclusion criteria, comprising case reports, case series, and retrospective analyses. PDT was applied preoperatively to debulk tumors, postoperatively to treat residual superficial disease, postoperatively to enhance wound healing, or in special populations such as patients with nevoid basal cell carcinoma syndrome. Across studies, recurrence rates did not significantly differ from MMS alone where assessed. Cosmetic outcomes were variably reported, with high patient satisfaction frequently noted. Adverse effects were generally mild and transient.

Evidence for PDT combined with MMS is limited to small, heterogeneous studies. Current data support selective use in specific scenarios, but further prospective, controlled studies with standardized outcome measures are needed to clarify its role in clinical practice.