NEW research suggests that Mohs micrographic surgery (MMS) alone may lead to lower recurrence rates than when combined with photodynamic therapy (PDT) in treating locally advanced basal cell carcinoma (laBCC), particularly in non-aggressive subtypes.
In a retrospective cohort study involving 63 patients with histologically confirmed laBCC, outcomes from MMS monotherapy were compared to MMS followed by PDT. Patients were not randomized; treatment decisions reflected real-world clinical practices based on tumor characteristics and patient profiles. Tumors were stratified into aggressive and non-aggressive categories, and recurrence, recurrence-free survival (RFS), and surgical margins were assessed as clinical endpoints.
Surprisingly, recurrence occurred less frequently in the MMS-only group, with a rate of 4.4%, compared to 22.2% in the MMS+PDT group. When examining tumor subtype, non-aggressive tumors treated with the combination approach demonstrated a recurrence rate of 16.7%, while aggressive subtypes, such as infiltrative, basosquamous, and morpheaform variants, showed a higher recurrence rate of 25%.
These findings suggest that PDT may not confer a recurrence advantage when added to MMS and may be less effective for aggressive histologies. Mean recurrence-free survival (mRFS) was slightly longer for non-aggressive tumors at 54 months (95% CI: 50–57.3 months) versus 52.3 months (95% CI: 51–56.2 months) for aggressive tumors, indicating a trend toward more favorable long-term outcomes in less invasive subtypes.
While PDT remains a valuable non-invasive option in dermatologic oncology, its role as an adjunct to MMS in laBCC warrants further scrutiny. These results underscore the continued efficacy of MMS as a standalone intervention, especially in non-aggressive basal cell carcinomas. Future prospective studies may clarify the subset of patients, if any, who might benefit from combination therapy.
Reference:
Gahimbare F et al. A comparative analysis of Mohs micrographic surgery with or without photodynamic therapy for locally advanced basal cell carcinoma. Photodiagnosis Photodyn Ther. 2025:104633. [Online ahead of print].
