Mosterd K et al. (2008) 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. Lancet Oncol 9: 1149–1156

A randomized study from The Netherlands suggests that Mohs micrographic surgery is superior to surgical excision as treatment for recurrent basal-cell carcinoma (BCC) of the face.

In an intention-to-treat analysis with 5 years' follow-up, Mosterd et al. randomly assigned 374 patients with 408 primary BCCs, and 191 patients with 204 recurrent BCCs, to undergo either Mohs micrographic surgery or surgical excision. Full follow-up data were available for 251 patients with 271 primary BCCs and 137 patients with 146 recurrent BCCs. Four recurrences (2.5%) of primary BCC after Mohs micrographic surgery occurred during follow-up, compared with seven recurrences (4.1%) after surgical excision; the difference was not statistically significant. Twelve recurrences occurred in the patients with recurrent BCC: two (2.4%) in those treated with Mohs micrographic surgery, and ten (12.1%) in those who underwent surgical excision; this difference was significant (P=0.015). The incremental cost-effectiveness ratios per recurrence avoided were €23,454 for primary BCC and €3,171 for recurrent BCC.

The authors conclude that Mohs micrographic surgery should be preferred to surgical excision for treatment of recurrent BCC. Surgical excision is probably preferable for most cases of primary BCC on the basis of cost-effectiveness. However, for more-aggressive subtypes of facial primary BCC, because of the increased risk and the adverse cosmetic effect associated with repeated surgery, Mohs micrographic surgery is recommended.