Mohs micrographic surgery in the treatment of basal cell carcinoma on the face

Oh, Kyoung; Kim, Jeong Tae; Jung, Young Ha; Kim, Seok Kwun; Kim, Ki Ho; Joe, Gwang Yeol

Abstract

Most of the basal cell carcinomas (BCCs) are effectively treated using standard conventional therapeutic modalities, but the complete removal of the tumor is difficult if the subclinical extension of BCCs is deep and wide. These difficulties are solved by Mohs micrographic surgery which provides the highest possible cure rates and the lowest normal tissue loss. Mohs micrographic surgery is an ideal method for the treatment of skin cancer in that it provides unsurpassed cure rates and maximum preservation of normal tissue by complete surgical margin control. We studied 40 patients with 40 basal cell carcinomas (22 primary, 18 recurrent) treated by Mohs micrographic surgery from January, 1992 through October, 1995 at Dong-A University Hospital. We evaluated the depth and lateral margins of excision by Mohs microgrphic surgery according to the anatomic locations, histologic type, size, and primary/recurrent state of basal cell carcinomas. There was no recurrence during follow-up period up to 3 years. We can draw the guidelines for complete surgical margin control out of our results. The guidelines are as follows. 1. The frist excision should be done with lateral safety margin of 2 mm in primary BBCs. 2. The frist excision should be done with lateral safety margin of 4 mm in recurrent BBCs. 3. The frist excision should be done with lateral safety margin of 4 mm in longer than 15 mm-sized BBCs. 4. The additional excision should be done with the every 2 mm lateral safety margin until the tumor completely removed. 5. The frist excision should be done with the surgical depth to periosteum, perichondrium especially in BBCs on nose.