Surgical excision versus Mohs’ micrographic surgery for basal cell carcinoma of the face: A randomised clinical trial with 10 year follow-up

• Published in: European journal of cancer (1990) Vol. 50; no. 17; pp. 3011 - 3020
• Main Authors: van Loo, Eva, Mosterd, Klara, Krekels, Gertruud A.M, Roozeboom, Marieke H, Ostertag, Judith U, Dirksen, Carmen D, Steijlen, Peter M, Neumann, H.A. Martino, Nelemans, Patty J, Kelleners-Smeets, Nicole W.J
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier 01.11.2014
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Basal Cell - mortality; Carcinoma, Basal Cell - surgery; Facial Neoplasms - mortality; Facial Neoplasms - surgery; Female; Follow-Up Studies; Hematology, Oncology and Palliative Medicine; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Mohs Surgery - methods; Mohs Surgery - mortality; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Recurrence, Local - etiology; Pharmacology. Drug treatments; Prospective Studies; Treatment Outcome; Tumors; Surgical excision; Basal cell carcinoma; Facial; Mohs surgery; Randomised controlled trial; Skin disease; Excision; Keratinocyte cancer; Malignant tumor; Randomized controlled trial; Mohs micrographic operation; Cancerology; Treatment; Follow up study; Surgery; Microsurgery; Clinical trial; Face; Comparative study; Cancer
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2014.08.018

Abstract Background Basal cell carcinoma (BCC) is the most common form of cancer among Caucasians and its incidence continues to rise. Surgical excision (SE) is considered standard treatment, though randomised trials with long-term follow-up are rare. We now report the long-term results of a randomised trial comparing surgical excision with Mohs’ micrographic surgery (MMS) for facial BCC. Methods 408 facial, high risk (diameter at least 1 cm, H-zone location or aggressive histological subtype) primary BCCs (pBCCs) and 204 facial recurrent BCCs (rBCCs) were randomly allocated to treatment with either SE or MMS between 5th October 1999 and 27th February 2002. The primary outcome was recurrence of carcinoma. A modified intention to treat analysis was performed. Findings For primary BCC, the 10-year cumulative probabilities of recurrence were 4.4% after MMS and 12. 2% after SE (Log-rank test χ2 2.704, p = 0.100). For recurrent BCC, cumulative 10-year recurrence probabilities were 3.9% and 13.5% for MMS and SE, respectively (Log-rank χ2 5.166, p = 0.023). A substantial proportion of recurrences occurred after more than 5 years post-treatment: 56% for pBCC and 14% for rBCC. Interpretation Fewer recurrences occurred after treatment of high risk facial BCC with MMS compared to treatment with SE. The proportion of recurrences occurring more than 5 years post-treatment was especially high for pBCC, stressing the need for long-term follow-up in patients with high risk facial pBCC.