Mohs micrographic surgery versus conventional surgical excision in basal cell carcinoma: a comparative review of the literature

Abstract

Basal cell carcinoma (BCC) is the most common malignant skin neoplasm and has a high worldwide incidence, representing a significant public health concern. Among the available treatment modalities, conventional surgical excision and Mohs micrographic surgery are widely used in the management of this disease. This study aimed to compare the effectiveness of these two surgical approaches through an integrative literature review. A bibliographic search was conducted in the PubMed/MEDLINE, ScienceDirect, and SciELO databases using descriptors related to basal cell carcinoma and the surgical techniques under investigation. Randomized clinical trials, observational studies, systematic reviews, meta-analyses, and clinical guidelines comparing the two treatment modalities were included. The final sample consisted of nine studies. The results demonstrated that Mohs micrographic surgery provides lower tumor recurrence rates, greater accuracy in surgical margin control, and better tissue preservation when compared with conventional surgical excision, particularly in high-risk, recurrent tumors or lesions located in anatomically critical areas. On the other hand, conventional excision remains an effective alternative for low-risk primary lesions, offering high cure rates and lower operational costs. It is concluded that Mohs micrographic surgery represents the most advantageous approach in clinically complex cases, whereas conventional surgical excision continues to be a safe and effective therapeutic option when appropriately indicated.