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Mohs micrographic surgery versus surgical excision for periocular basal cell carcinoma Updated

Narayanan K, Hadid OH, Barnes EA
Published Online: 
12 December 2014

Review question
To compare the effectiveness, cost, complications and acceptability of two different surgical techniques for treating basal cell carcinoma (BCC) around the eyes.

Background
BCC is the commonest skin cancer and the most common cancer in people of white origin. It is usually seen on the sun exposed parts of the body like the face, neck, head and ears. Untreated lesions can slowly eat away the surrounding skin and hence they are also called "rodent ulcers".

The commonest treatment for BCC is surgery. This is traditionally achieved by surgical excision (SE) which involves cutting away the BCC, along with a margin of normal appearing skin around it to ensure complete removal of the cancer and to reduce the risk of recurrence.

Another type of surgery is Mohs micrographic surgery (MMS). This involves the removal of the skin tumour after colour coding the edges. This is then examined under the microscope to see if all the BCC has been removed. If any residual BCC is left at any particular edge further skin is removed from only that localised area by using the colour coding, and examined under the microscope. This process is continued until all the BCC is removed. This ensures complete tumour removal and spares normal tissue in the other directions.

MMS is considered the better alternative for treatment of certain types of BCC arising in the eyelids because it has the highest chance of curing the disease and minimises the size of the defect that needs to be repaired.

Unfortunately, this treatment is not available everywhere and not always employed because of practical limitations in the service delivery.

Surgical excision is thought to be a cheaper option as it does not require the special training, multiple procedures, and money involved in setting up and running a MMS service. However, longer duration of follow up, greater surgical morbidity and the cost of dealing with recurrences may over time significantly increase the cost of SE.

Study characteristics
We searched for studies where people with BCC had been randomly selected to be treated by one or the other method. The aim was to establish which treatment method is associated with lower recurrence rate. We also looked at the cost difference, complications and acceptability of the two procedures.

Key results
No studies were found that met the inclusion criteria.

This record should be cited as: 
Narayanan K, Hadid OH, Barnes EA. Mohs micrographic surgery versus surgical excision for periocular basal cell carcinoma. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD007041. DOI: 10.1002/14651858.CD007041.pub4
Assessed as up to date: 
25 February 2014