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Is Clinical Recurrence Required for Mohs Micrographic Surgery?

asked 3 years ago by trufa in san diego
Latest answer by Robert Strimling, MD
Question viewed 2,319 times
Tags: basal cell carcinoma, maxillary

I have Basal Cell Carcinona (BCC) in the face (upper maxilla ), and it was removed on November 22, 2008. However, the surgeon did an incomplete primary excision and the biopsy showed positive margins for BCC. I did some research, and the Mohs Micrographic Surgery (MMS) is a good option for the recurrent BCC. Do I need to have a clinical recurrence to undergo MMS?

20 answers to Is Clinical Recurrence Required for Mohs Micrographic Surgery?

Indications for Mohs surgery

One of the best indications for Mohs surgery is a recurrent tumor. When a skin cancer recurs it may have scar tissue mixed in with the tumor cells which may make other treatment options (e.g. radiation or other destructive techniques) less effective. However, in addition to recurrent tumors Mohs is also a good option for tumors with poorly defined clinical margins (i.e. can't tell where the tumor ends and normal skin begins), tumors with agressive appearances under the microscope,... more

Andrew Kaufman, MD
Los Angeles Dermatologic Surgeon

www.dermatology-center.com

When to get Mohs

Mohs allows for the maximal amount of tissue conservation when it comes to dermatologic cancer resections. It can be indicated for any skin cancer on the face (or any other part of the body) if resection of that tissue is likely to leave a significant scar or a scar that can alter the function of things like the eyelids. Just because you have positive margins may not mean you NEED Mohs if the treating physician feels that the resulting defect is likely to be similar or the reconstruction... more

Steven H. Williams, MD
San Francisco Plastic Surgeon

No, you should probably have it now

While this doesn't substitute for a consultation with a qualified plastic surgeon, it sounds as though you might now be a candidate for Moh's. The advantage of this would be to remove all BCC with clear margins and a minimal recurrence risk while sparing as much normal tissue as possible especially on your face. A proper reconstruction can then be done preferably by a plastic surgeon, not the Moh's dermatologist.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Mohs is best treatment option for skin cancer on face.

No, you do not have to have a clinical recurrence to undergo MMS. Incomplete excision is an indication for Mohs Surgery of skin cancer.

Robert Strimling, MD
Las Vegas Dermatologist

Mohs indicated for skin cancer on the face

First of all, you should be commended for your research. And rest assure that Mohs surgery is the best option for you, it will leave you with the smallest scar possible and ensure that all the tumor is removed. Mohs surgery is perfectly indicated in your case-- having a skin cancer on the face that was incompletely removed the first time. You do not need to wait for clinically visible recurrence of the cancer before your proceed with Mohs surgery. I would advise you to consult... more

Margaret Mann, MD
Cleveland Dermatologic Surgeon

Positive margins on BCC excision Qualifies for MOHS

Hi, Medicare guidelines for Mohs include positive margins on excision, recurrence of tumor, high risk head and neck areas, anatomically important areas such as hands and feet, immunosuppressed patients, aggressive tumor subtypes. The beauty of Mohs is that is an elegant tissue sparing method of removal of certain skin cancers with a high cure rate.

Grace Liu, MD
Newport Beach Dermatologic Surgeon

Positive margin on a previous excision of BCC is a qualification for Mohs.

Good research on your part. An excision with a positive margin is a direct indication for Mohs and there is no need to wait for clinical (visible) recurrence of the basal cell carcinoma before proceeding to have Mohs to clear the margins. See only a fellowship-trained Mohs surgeon (American College of Mohs Surgery or Procedural Dermatology Fellowship) to investigage your options for best results.

Jessica J. Krant, MD, MPH
Manhattan Dermatologic Surgeon

Mohs not just for recurrent tumors

There are several indications for using MOhs surgery. Recurrent basal cells or squamous cells are one indication. Other reasons for Mohs include tumors with poorly defined edges or borders where it is unclear where the tumor starts or stops. Any tumor that is in a cosmetically sensitive location such as the eyelid or near the eye or nose or ear are always appropriate to use the Mohs surgery procedure. Less common types of tumors such as dermatofibrosarcoma protuberans,... more

Edgar Franklin Fincher, MD, PhD
Beverly Hills Dermatologic Surgeon

Mohs surgery indications

Clinical recurrence is one of the indications for Mohs Micrographic surgery. Other indications refer to poorly defined margins, high risk tumors, location on body, and then size of tumor.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon

www.palmbeachdermasurgery.com

Moh's Surgery

The Mohs technique is best applied in aesthetically sensitive areas of the face (eyelid, nasal tip, lips) where tissue conservation is paramount. As other posters have stated, it offers the lowest recurrence rate amongst incisional techniques. It is also indicated for recurrent squamous cell and basal cell carcinomas (not for melanoma). In my practice, I often refer skin cancer patients to a local Mohs surgeon and I subsequently perform reconstruction when the margins have been cleared. ... more

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon

Moh's micrographic surgery for primary lesions in critical areas

Moh's is not limited to recurrent lesions. It is useful in areas where conservative resection, but complete, aids reconstruction. The lower eyelid is a good example.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon

Mohs surgery has the highest cure rate

Mohs surgery has the highest cure rate and thereby lowest chance of recurrence. There are criterias used in deciding whether Mohs or primary excision are the treatment of choice which could be determined by your Mohs surgeon. In general, if there is a skin cancer on the face close to the free margin or on the nose, around the eyes and mouth and ear, Mohs surgery would be indicated. It does not necessarily need to be a recurrence for it to be qualified, even though it does minimize the... more

Peyman Ghasri, MD
Los Angeles Dermatologist

Many indications for Mohs surgery

While a recurrent cancer is definitely a reason to have Mohs surgery, Mohs surgery is also indicated for cancers with several other characteristics as well. These include cancers that are: - Located in the central face - Near important structures (eyelids, lips, nose, ears) - In a patient younger than 40 - Greater than 1.5 to 2.0 cm in size - Demonstrates poorly defined margins - Of a questionable depth - Recurrent - An unusual tumor type or subtype - In a patient with a history of multiple... more

Chad L. Prather, MD
Baton Rouge Dermatologist

Mohs Treatment of Choice

Mohs Surgery would be the treatment of choice for an incomplete excision. In the "Old Days" it might be recommended to wait for a clinical recurrence. However, if the deep margin was postive that tumor will grow and grow until it resurfaces. By waiting you are only allowing the tumor to get bigger and bigger and will require a more extensive procedure. For a highly trained Mohs Surgeon in your area I would check out the website of the American College of Mohs Surgery. Only... more

Jerome Potozkin, MD
Walnut Creek Dermatologic Surgeon

Visit your facial plastic surgeon now!

If you indeed have a positive margin after excision of any type of cancer, I would talk with your surgeon or find a facial plastic surgeon to discuss your options. Depending on the exact location of the tumor, Mohs surgery might be an excellent option but you should not wait until you see a recurrence to seek treatment.

D.J. Verret, MD
Dallas Facial Plastic Surgeon

Mohs indicated for cosmetically sensitive areas, recurrence, and aggressive pathology

Mohs micrographic surgery is indicated for cosmetically sensitive areas, recurrence, and aggressive pathology. The repair is typically performed by Mohs surgeon who is typically quite comfortable with most repairs including flaps and grafts. On occasions, Mohs surgeon may coordinate with a plastic surgeon where the Mohs surgeon will take care of the eradication of tumor with maximal preservation of unaffected tissue and the plastic surgeon may take care of reconstructive surgery either on... more

William Ting, MD
Bay Area Dermatologic Surgeon

The sooner Mohs Surgery is done, the better

Hi Trufa, I agree that it is best to have Mohs surgery now. There is no doubt that it provides the highest cure and lowest recurrence rates. The fact that the tumor was not completely removed with standard excision margins definitely suggests that Mohs is indicated. Why wait? You are lucky enough to know early on that there is still tumor present rather than have it become clinically apparent. This affords you the advantage of having a smaller scar by sparing more normal surrounding tissue... more

Ritu Saini, MD
New York Dermatologic Surgeon

Mohs surgery is preferable

If you have skin cancer (basal cell or squamous cell), it is preferable to have mohs surgery. You do not need to have a recurrence to get mohs. What is mohs? Mohs skin cancer surgery allows for the tissue to be examined during the operation through a microscope to ensure that all of the cancer cells have been removed adequately, and that removal of healthy, cancer-free tissue is minimized. Using the Mohs microscopic surgery technique there is a 95% cure rate. Mohs skin cancer surgery is then... more

Jonathan Hoenig, MD
Beverly Hills Oculoplastic Surgeon

Mohs surgery only requires skin cancer diagnosis

There is no question that Mohs surgery provides the highest cure rate for the treatment of skin cancer. As opposed to standard excision performed by plastic surgeons, primary care physician's, dermatologist, etc., Mohs surgery has significantly higher cure rates. A five-year study shows that Mohs surgery for most skin cancers has a 97 to 99% cure rate. Standard excision has a 90% cure rate. The other advantage of Mohs surgery is that 100% of the tissue is examined when it is removed by a... more

Shawn Allen, MD
Boulder Dermatologist

A clinical recurrence is not required for Mohs surgery.

Mohs surgery is an appropriate method to treat an incompletely excised skin cancer on the face. Because the margins of the excision specimen were positive for tumor, we would need to assume that if you were to wait long enough, a clinical recurrence would eventually occur, that is visible tumor would eventually declare itself. While not an urgent matter, I suggest you do not wait longer than 1-3 months before undergoing Mohs, as the tumor will grow wider, dive deeper and require a more... more

Bryan K. Chen, MD
San Diego Dermatologist

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