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Mohs vs. Conventional Surgery

By December 28, 2008

The most common treatment for nonmelanoma skin cancer such as basal cell carcinoma (BCC) is surgery: either simple surgical excision (removal) or Mohs surgery. Excision is used to treat both primary and recurrent tumors and involves surgically removing the tumor and a certain amount of normal-appearing skin surrounding it (the "margin"). The Mohs procedure is more complex: it involves removing thin sections of the skin growth one at a time, each of which are individually examined under a microscope until no cancerous cells remain. However, clinical trials directly comparing the effectiveness of the two techniques are few and far between.

Klara Mosterd, MD and colleagues at Maastricht University in the Netherlands recently published just such a study. Over 400 patients were treated with either of the two techniques and then followed for five years. The results showed that Mohs surgery is more effective than surgical excision for the treatment of recurrent BCC on the face, since there were significantly fewer recurrences. However, because there was no significant difference in recurrence of primary BCC between the two groups, treatment with surgical excision is probably sufficient in most cases of primary BCC.

Although this is just one study, it's a potentially important one for public policy. Excision is less expensive than Mohs, so in this age of tightening health care costs, it could be used more often to treat certain types of basal cell carcinoma in the future.


Mosterd K, Krekels GA, Nieman FH, et al. "Surgical excision versus Mohs' micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years' follow-up." 2008. Lancet Oncol 9(12):1149-56. 27 December 2008.

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