Does This Skin Cancer Really Need Mohs?

In recognition of National Skin Cancer Month, the Journal of Drugs in Dermatology and our industry partners, Next Steps, are taking a look back at an engaging panel discussion, “Does This Skin Cancer Really Need Mohs?,” from the 17^th Annual ODAC Dermatology, Aesthetic and Surgical Conference in Orlando, Florida.

The case-based discussion examined the use of Mohs micrographic surgery (MMS) versus other treatment modalities for non-melanoma skin cancers, Merkel cell carcinoma, and lentigo maligna.

by Yumeng Marina Li, MD

The first case described a 41-year-old Fitzpatrick type II female with two superficial basal cells on her right central cheek (5×7 mm) and right chin (6×8 mm). Mohs Appropriate Use Criteria (AUC) score is 7 for both lesions, justifying MMS for both lesions. Pretty straightforward right?

Think again. Dr. Patel implored the use of topical immunotherapy with imiquimod for these lesions given a study by Williams et al. (1). This randomized clinical trial examined the interventions of either imiquimod 5% cream once daily (superficial basal cell carcinoma, 6 weeks; nodular basal cell carcinoma, 12 weeks) or excisional surgery (4-mm margin) on 3- and 5-year success rates. The 3-year success rate was defined as the clinical absence of initial failure or signs of recurrence at the 3-year dermatology review, and Five-year success was defined as 3-year success plus absence of recurrences identified through medical records. The 5-year success rates for imiquimod were 82.5% compared with 97.7% for surgery (relative risk of imiquimod success = 0.84, 95% confidence interval = 0.77-0.91, P < 0.001). These were comparable to year 3 success rates. Most imiquimod treatment failures occurred in year 1.

This information was presented by Dr. Vishal Patel and Dr. Sailesh Konda at the 17^th ODAC Dermatology, Aesthetic and Surgical Conference held January 17^th-20^st, 2020 in Orlando, FL.

Further case highlights can be reviewed by visiting Next Steps in Derm.

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