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Updated: Jul 14, 2026
Establishment of a Clinic-based Biorepository
Published on: May 29, 2017
Collaboration Between Mohs and Surgical Subspecialists in the Treatment of Advanced Nonmelanoma Skin Cancer
Caroline L Mortelliti1, Haley A Neff1, Brenda T Solomon1
1Department of Mohs Micrographic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Background:
Locally advanced and metastatic nonmelanoma skin cancers are frequently managed with operating room (OR)-based resection, lacking real-time margin assessment. Mohs micrographic surgery provides immediate margin evaluation but is limited in deeply invasive or metastatic disease. A coordinated approach combines the strengths of both strategies.
Methods:
Retrospective cohort study of patients with locally advanced tumors, with or without regional metastases, treated with Mohs surgery followed by OR resection.
Results:
Twenty-one patients had median follow-up of 30 (IQR, 14-87) weeks. Mohs cleared the peripheral margin in all cases and the deep margin in 11 (52%) cases. Ten (48%) cases required OR resection of the deep margin, and 10 (48%) required resection of metastatic disease. Median time between surgeries was 2 (IQR, 1-16) days. Three patients (14%) developed recurrence. No disease-specific deaths occurred.
Conclusion:
Coordinating Mohs surgery with OR resection enables full margin assessment, surgical clearance of extensive disease, and immediate reconstruction.
Insights
Combining Mohs surgery with operating room (OR) resection improves margin assessment for advanced nonmelanoma skin cancers. This coordinated approach ensures complete tumor removal and facilitates immediate reconstruction.
Area of Science:
- Dermatology
- Surgical Oncology
Background:
- Advanced nonmelanoma skin cancers often require operating room (OR) resection but lack real-time margin assessment.
- Mohs micrographic surgery offers immediate margin evaluation but is limited for deeply invasive or metastatic disease.
- A combined strategy leverages the strengths of both Mohs surgery and OR resection.
Purpose of the Study:
- To evaluate the efficacy of a coordinated approach combining Mohs surgery with OR resection for locally advanced and metastatic nonmelanoma skin cancers.
- To assess margin clearance, need for further resection, and patient outcomes.
Main Methods:
- Retrospective cohort study.
- Patients with locally advanced nonmelanoma skin cancers, with or without regional metastases, underwent Mohs surgery followed by OR resection.
- Analysis of margin status, subsequent resections, recurrence rates, and follow-up.
Main Results:
- Mohs surgery achieved peripheral margin clearance in all 21 patients.
- Deep margin clearance was achieved in 52% of cases by Mohs surgery alone.
- 48% of cases required OR resection for deep margins, and 48% required resection of metastatic disease.
- Median follow-up was 30 weeks, with a 14% recurrence rate and no disease-specific deaths.
Conclusions:
- Coordinating Mohs surgery with OR resection provides comprehensive margin assessment for complex nonmelanoma skin cancers.
- This integrated approach facilitates complete surgical clearance of extensive disease and enables prompt reconstruction.
- The combined strategy appears safe and effective in managing challenging cases.
