Consistency in Distribution of Facial Skin Cancers Treated With Mohs Micrographic Surgery

May 2022 | Volume 21 | Issue 5 | 506 | Copyright © May 2022

Published online April 15, 2022

Joshua Horeczko BAa, Ali Hendi MDb,c

aGeorgetown University School of Medicine, Washington, DC
bMedStar-Georgetown University Hospital Department of Dermatology, Washington, DC
cPrivate practice, Chevy Chase, MD

Mohs micrographic surgery (MMS) has become the standard of treatment for skin malignancies of the head and neck. However, there is a paucity of literature describing facial distributions of MMS. Anatomical location of skin cancer is an important feature to study as it can affect prognosis as well as pathogenesis of skin cancers. This study aims to analyze consistency in head and neck MMS anatomical distributions and compare differences between multiple centers. The study retrospectively reviews 5871 MMS cases performed at a single center in Chevy Chase, Maryland from January 2014 through December 2019. Results show distributions of skin cancers on the face treated with MMS consistently occur at the same anatomical sites year after year with minimal variance. This knowledge of consistency provides a foundation for future studies because it allows for comparison. Comparing and contrasting data across multiple centers can elucidate regional characteristics that may impact the pathogenesis and distribution of facial skin tumors. Many regional or demographical factors may be important in the development of cutaneous malignancies. This information should be considered when assessing risk factors for cancerous skin lesions.

J Drugs Dermatol. 2022;21(5):506-509. doi:10.36849/JDD.6143


The incidence of keratinocyte carcinoma (KC), which consists of basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), has been increasing worldwide.1-2 Reporting to cancer registries is not required for these tumors but in 2012, an estimated 5.4 million cases were diagnosed in the United States.1 In addition, the incidence of melanoma and melanoma in situ has been increasing significantly.3 These disturbing trends warrant further investigation into risk factors influencing skin cancer pathogenesis.

Multiple treatments are available for skin cancer but Mohs micrographic surgery (MMS) has repeatedly demonstrated the highest cure rates and best cosmetic results.4-6 This is achieved by histologically analyzing tissue margins during the procedure to ensure complete tumor resection while minimizing excision of healthy tissue. The cost-effectiveness of MMS is also comparable to traditional excision.7-10 MMS is typically indicated for skin cancers on facial areas as these locations are at greatest risk for recurrence and are of high cosmetic value.

The majority of MMS procedures are performed on head and neck tumors. Yet, a limited number of studies have described distributions of head and neck MMS. The data in this study offers a detailed analysis of facial MMS procedures from a single practice in the DC metropolitan area, which demonstrates an incredibly consistent pattern every year. This study aims to establish that there are persistent patterns in the anatomical locations of MMS procedures. By demonstrating that there are consistent patterns in this surgical technique, we can compare and contrast various trends and regional demographics to investigate factors affecting skin cancer prevalence.


Patient Characteristics
A retrospective chart review was performed on all patients treated with MMS at a private practice in Chevy Chase, Maryland from January 1, 2014, through December 31, 2019. Chevy Chase is a suburban region of the DC metropolitan area with a population density of 3,987 people per square mile. Citizen demographics are primarily Caucasian (84.9%), highly educated (85.5% with a bachelor’s degree or higher), and an income per capita of 97,282 (in 2018 dollars).11 The climate can be described as a humid subtropical (Köppen climate classification Cfa) with hot humid summers and cold to mild winters. Cases of MMS were identified through accessing surgical data records. All procedures were performed in office by Mohs surgeon