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Mohs micrographic surgery versus surgical excision for periocular basal cell carcinoma

Narayanan K, Hadid OH, Barnes EA
Published Online: 
15 February 2012

A basal cell carcinoma (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 the edge of the excision further skin is excised 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. The latter 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 modality of therapy is a limited resource and not always employed because of practical limitations in the service delivery. Surgical excision is perceived 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. Extended follow up, greater surgical morbidity and the cost of dealing with recurrences may over time significantly increase the cost of SE. We searched for studies where people with BCC had been randomised to receive either method of treatment. 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. This review could not find enough evidence to answer these questions. There is a clear need for further randomised studies to provide more reliable evidence for the management of this condition.

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 2012, Issue 2. Art. No.: CD007041. DOI: 10.1002/14651858.CD007041.pub3
Assessed as up to date: 
23 November 2011