Cost-effectiveness of Mohs Micrographic Surgery vs Surgical Excision for Basal Cell Carcinoma of the Face

Essers, Brigitte; Dirksen, Carmen D.; Nieman, Fred; Smeets, N.W.J. Kelleners; Krekels, Gertruud A. M.; Prins, Martin H.; Neumann, H. A. Martino

doi:10.1001/archderm.142.2.187

Cited by 101 publications

(96 citation statements)

References 14 publications

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“…Although recently Mohs' micrographic surgery has been hailed as the best method of removing BCC with minimal recurrence, 8,[11][12][13] it may be too costly 14 and time consuming to be used for all periocular BCC. 15 In addition, it may not be available in every hospital.…”

Section: Discussionmentioning

confidence: 99%

5 Years review of periocular basal cell carcinoma and proposed follow-up protocol

Brown

Bamford

et al. 2012

Eye

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In all, 67% were nodular BCC and 45.4% located in the lower eyelid. The main outcome measure was the recurrence rate. None of the patients with primary nodular BCC suffered recurrence. The recurrence rate for primary morphoeaform BCC following complete excision is 3.8%. In total, 8.1% of patients had several lesions simultaneously whereas 7.8% patients had BCC in multiple locations subsequently (metachronous). Three patients who had previously recurrent BCC (rBCC) treated elsewhere or not using this method had orbital/lacrimal drainage system involvement requiring exenteration. Conclusion We recommend that patients with a single, completely excised primary solid or nodular BCC can be discharged after one 6-monthly review, although they should be instructed to monitor for the development of further lesions. The incidence of recurrence for primary morphoeaform BCC is 3.8% and for rBCC is 3.6% over 5 years and these patients should stay under review for this period.

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Section: Discussionmentioning

confidence: 99%

5 Years review of periocular basal cell carcinoma and proposed follow-up protocol

Brown

Bamford

et al. 2012

Eye

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“…A single Mohs cycle, excluding the excision itself, takes approximately 45 min and, therefore, is extremely time consuming (29). The results of cost analysis in many studies showed that the mean costs of MMS were significantly high, mainly due to longer surgery time and high costs of pathological examination (30). Because special training for MMS is required, the number of surgeons capable of performing MMS remains low and the technique is not available in every centre.…”

Section: Discussionmentioning

confidence: 99%

A reliable frozen section technique for basal cell carcinomas of the head and neck

Menesi¹,

Buchel²,

Hayakawa³

2014

CAN J PLAST SURG

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Basal cell carcinoma (BCC) is the most common skin cancer worldwide and represents 75% of cutaneous malignancies (1). The mortality rate from BCCs is <1% and metastases rarely occur (0.0028% to 0.5%) (2-6). Achieving clear margins, particularly with the more aggressive histological subtypes of BCC and in recurrent tumours, can prove challenging. In these scenarios, the visible clinical margin frequently underestimates the true extent of the tumour. This phenomenon is often referred to as subclinical tumour growth with fingerlike extensions. It is particularly common in the danger zone of the face (H zone), where BCCs often behave more aggressively and recur more frequently (7,8).Before reconstruction, it is imperative that the entire BCC be removed with negative pathological margins. Incomplete resection of primary and recurrent tumours can lead to substantial morbidity and even mortality (9). The majority of BCCs can be treated using standard techniques including conventional surgical excision, curettage, cryotherapy and radiotherapy. The recurrence rates for each of these techniques has been reported to be 3% to 42% following surgical excision (10-12), 3% to 9% with curettage (13,14), 4% to 17% following cryotherapy (10) and 7% to 10% after radiation (15).Mohs micrographic surgery (MMS) or frozen section have been recommended for difficult tumours such as recurrent tumours, tumours located in anatomically sensitive areas, aggressive histological subtypes, perineural invasion or large tumours >2 cm in size (7). Cure rates with MMS has proven better than with other treatment modalities, with low overall five-year recurrence rates of 0.6% to 3% for primary BCC, and 6% to 10% for recurrent . Disadvantages of MMS include the fact that it can be very time consuming, expensive and the reconstruction may be deferred if the Mohs surgeon is not comfortable with more involved reconstructive procedures.We evaluated the effectiveness of a surgeon-directed 'en face' frozen section technique that immediately evaluates the entire peripheral and deep margins during BCC resection and potentially offers a more efficient and equally effective alternative to MMS. METHODS PatientsThe study group comprised 50 patients who were treated by a single plastic surgeon (TH) in a tertiary centre. Fifty-three BCCs were evaluated. All tumours excised from the face over a five-year period (2002 to 2006) were retrospectively reviewed. The indications for 'en face' frozen section were recurrent tumours, tumours located in anatomically sensitive areas, aggressive histological subtypes, perineural invasion or large tumours >2 cm. The 'en face' method is a technique that permits examination of the entire tumour margin (20). The sections for the 'en face' method are cut very thin to enable maximal tissue preservation. Basal cell carcinomas (BCCs) of the head and neck treated by conventional techniques of surgical excision, curettage, cryotherapy and radiation therapy have recurrence rates of up to 42%. Mohs micrographic surgery (MMS) decreases the r...

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“…Moreover, recent reports supporting the role of Mohs surgery restrict the economic benefit of this technique to selected clinical settings involving high-risk skin cancers. [10][11][12] In the EPIDERM series, the risk of selection bias and the more specialized nature of university hospitals may also partially account for the differences observed. In Germany, most cases included in the EPIDERM study in inpatients of the dermatosurgery unit.…”

Section: Discussionmentioning

confidence: 99%

Assessing physicians’ preferences on skin cancer treatment in Europe

Ferrándiz¹,

Ruíz-de-Casas²,

Trakatelli³

et al. 2012

British Journal of Dermatology

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SummaryBackground A wide variety of both surgical and nonsurgical therapies is currently available for patients with skin cancer. Objectives This part of the EPIDERM (European Prevention Initiative for Dermatological Malignancies) project is aimed at the evaluation of the treatment preferences for skin cancer in eight countries of the European Union. Methods A multicentre hospital-based case-control study was carried out at dermatology departments in Finland, Germany, Greece, Italy, Malta, Poland, Scotland and Spain. Patients with skin cancer (basal cell carcinoma, actinic keratosis, squamous cell carcinoma, cutaneous malignant melanoma and Bowen disease) were consecutively enrolled between July 2008 and July 2010. Information on the study variables (sex, age, country, tumour type, anatomical location and treatment) was obtained from questionnaires designed by the EPIDERM project. Results In total, 1708 patients with skin cancer were included. Surgery was the first treatment option in 76AE5% of the patients (P = 0AE001). Actinic keratosis was the only tumour type in which nonsurgical treatment was more frequent than surgery (91AE4%). Tumours on the head were less likely to be surgically excised than those at other locations (odds ratio 0AE25, P = 0AE001). Simple excision or curettage was the most common surgical procedure (65AE4%), followed by graft and flaps (22AE4%). Cryotherapy was the most common nonsurgical option (52AE4%), followed by imiquimod (18AE0%), photodynamic therapy (PDT; 12AE0%), 5-fluorouracil (5-FU; 5AE7%), and diclofenac with hyaluronic acid (4AE0%). Conclusions Surgery remains the first-choice treatment of skin cancer. Regarding nonsurgical treatments, the conservative treatments available (imiquimod, PDT and diclofenac gel) have not yet exceeded the use of ablative options such as cryotherapy despite their accepted benefit of treating field cancerization.

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Cost-effectiveness of Mohs Micrographic Surgery vs Surgical Excision for Basal Cell Carcinoma of the Face

Cited by 101 publications

References 14 publications

5 Years review of periocular basal cell carcinoma and proposed follow-up protocol

5 Years review of periocular basal cell carcinoma and proposed follow-up protocol

A reliable frozen section technique for basal cell carcinomas of the head and neck

Assessing physicians’ preferences on skin cancer treatment in Europe

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