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Mohs Surgery vs. Wide Local Excision for Non-Melanoma Skin Cancer: Comparing Recurrence Rates, Economic Value, and
Kimia Heidari1, Seyedshayan Shojaei2, Haiyue Jin1
1School of Medicine, University of California at Irvine, Irvine, Irvine, CA 92697 USA.
Background:
Non-melanoma skin cancer (NMSC), comprising basal-cell carcinoma (BCC) and cutaneous squamous-cell carcinoma (cSCC), represents the most common malignancy worldwide. Surgical management remains the gold standard, yet the choice between Mohs micrographic surgery (MMS) and wide local excision (WLE) continues to generate debate due to differences in recurrence, cost, and cosmetic outcomes.
Objective:
To systematically compare MMS and WLE across three domains: long-term recurrence rates, cost-effectiveness, and aesthetic outcomes.
Methods:
A contemporary synthesis of prospective cohorts, registries, randomized trials, and economic models was performed. Outcomes included 5-year recurrence, incremental cost-effectiveness ratios (ICERs), quality-adjusted life years (QALYs), and validated patient-reported scar assessments.
Results:
For high-risk facial BCC and cSCC, MMS reduced 5-year recurrence to ≤ 1% compared with 3-5% after WLE (number-needed-to-treat = 28). Tissue-sparing margins yielded scars 1-2 mm narrower and 38% smaller in surface area, increasing the probability of "good/excellent" cosmesis by 12% per mm saved. Economic analyses demonstrated that, despite higher upfront procedural costs, MMS dominated WLE by saving ≈ $330 per patient and gaining 0.04 QALY over five years. Population-level adoption for intermediate-risk cSCC projected an annual payer surplus of ≈ $200 million and >25,000 QALYs. Patient-reported outcomes (POSAS, SCAR-Q, and FACE-Q) consistently favored MMS, with ≥ 90% rating scars as "good/excellent" versus 74% after WLE.
Conclusion:
MMS provides superior oncologic control, cosmetic outcomes, and cost-effectiveness compared with WLE for high-risk NMSC. Expanding MMS capacity and embedding patient-centered decision aids could optimize value-based care and deliver durable clinical and economic benefits.
