MOHS surgery produced smaller defects without a significant difference in five-year recurrence after cutaneous squamous cell carcinoma.
A prospective multicenter cohort study compared outcomes after Mohs micrographic surgery and standard excision for primary cutaneous squamous cell carcinoma (CSCC). Although Mohs surgery was more frequently used for higher-risk tumors, adjusted analysis found no statistically significant difference in recurrence between the procedures.
The study included 761 patients with 903 completely excised primary CSCCs treated at six centers in the Netherlands. Standard excision was used for 629 tumors, while 274 underwent Mohs surgery.
Tumors selected for Mohs surgery were more likely to have characteristics associated with higher clinical complexity. Overall, 55% were classified as American Joint Committee on Cancer eighth edition stage T2 or higher, compared with 25% of tumors treated through standard excision. Mohs-treated tumors were also more frequently located in the facial H-zone, at 77% versus 37%.
At five years, the cumulative incidence of recurrence was 1.7% after standard excision and 3.3% after Mohs surgery. After adjustment for tumor stage, Mohs surgery was not associated with a statistically significant difference in recurrence compared with standard excision. The adjusted subdistribution hazard ratio was 1.51, with a 95% confidence interval of 0.66–3.44.
The findings should not be interpreted as demonstrating that one procedure is more effective. Treatment was not randomly assigned, Mohs surgery was preferentially used for higher-risk tumors, and relatively few recurrence events occurred.
Five-year metastasis incidence was low in both groups, reaching 0.8% after standard excision and 1.1% after Mohs surgery.
A clearer difference emerged in tissue preservation. The ratio of final surgical defect size to initial tumor size was 1.2 with Mohs surgery, compared with 3.0 following standard excision.
This smaller defect ratio supports the clinical value of Mohs surgery when treating CSCC in cosmetically or functionally sensitive locations. Complete margin assessment may allow surgeons to preserve more unaffected tissue while achieving tumor clearance.
The investigators concluded that definitive comparisons of efficacy will require further research. However, the observed tissue-sparing advantage supports selective use of Mohs surgery when minimizing surgical defects is an important treatment consideration.
Reference
Eggermont CJ et al. Five-year recurrence rate of cutaneous squamous cell carcinoma after Mohs micrographic surgery versus standard excision: a prospective multicentre cohort study. Br J Dermatol. 2026;DOI: 10.1093/bjd/ljag399.
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