Is Clinical Recurrence Required for Mohs Micrographic Surgery?

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?

Doctor Answers 20

When to get Mohs

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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 options will not substantially change with comparison to normal surgical resection.

You should talk to BOTH the Mohs dermatologic surgeon and your planned reconstructive surgeon to get the treatment options that are best suited to your needs.

I hope this helps.

No, you should probably have it now

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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.

Mohs is best treatment option for skin cancer on face.

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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
4.3 out of 5 stars 9 reviews

Indications for Mohs surgery

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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, tumors on areas at higher risk of recurrence or where we want to preserve the greatest amount of healthy tissue (e.g. eyelids, nose, lips, ears), and  large tumors (greater than about one-half inch on the face and three-quarters of an inch on the trunk or extremities). Also patients who may be immunosuppressed due to disease or medications and young patients or others with a tumor in a very cosmetically sensitive area may be considerations for Mohs surgery.

Andrew Kaufman, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 16 reviews

Mohs indicated for skin cancer on the face

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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 with a fellowship-trained Mohs surgeon.  These are dermatologist like myself who have taken an additional year of fellowship training specifically to treat skin cancers.  In addition, fellowship trained Mohs Surgeons are well versed in advanced facial reconstruction techniques.  You should check to see if your physician is a part of the American College of Mohs Surgery.  


Dr. Mann

Margaret Mann, MD
Cleveland Dermatologic Surgeon

Positive margins on BCC excision Qualifies for MOHS

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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
4.9 out of 5 stars 52 reviews

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

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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
New York Dermatologic Surgeon
4.7 out of 5 stars 41 reviews

Mohs not just for recurrent tumors

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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, atypical fibroxanthomas and others are treated with Mohs.

Edgar Franklin Fincher, MD, PhD
Beverly Hills Dermatologic Surgeon

Mohs surgery indications

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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

Moh's Surgery

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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. Whether or not an insurance company will allow the referral is a separate issue.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.