Non-Mohs Micrographic Surgery Options

Topical therapy is best for pre-cancers (actinic keratoses) and some physicians may recommend it for non-aggressive forms of skin cancer such as superficial basal cell carcinoma. Examples of topical therapies are Efudex cream (5-fluourouracil) and Aldara cream (imiquimod). The primary advantage of using topical therapy is avoidance of surgical procedures and potential scarring. However, topical therapies have lower cure rates than surgery and often require application of creams that irritate the skin for weeks or months. Another potential problem is that topical therapy may only remove the superficial portion of the tumor and mask deeper tumor roots.

Destruction techniques are best for non-aggressive types of skin cancer. Examples of destruction techniques are electrodessication and curettage (“scraping and burning”), cryotherapy (liquid nitrogen), and laser therapy. Laser surgery is very useful for very superficial skin cancers because it selectively removes the first layer of skin. Destruction techniques are quick to perform. Cure rates are lower compared to surgery because destruction techniques do not allow for microscopic examination of surgical margins and may allow persistence of deeper tumor roots.

Radiation therapy is best reserved for patients who cannot tolerate the other procedures described herein. Although radiation treatments are painless, they are expensive and often require multiple trips to the radiation treatment center. Cure rates are lower compared to surgery and recurrences are often difficult to manage. Another problem is that ionizing radiation is carcinogenic and may cause other skin cancer development.

Excisional surgery is used for all types of skin cancer and the technique depends on surgical removal of predetermined safety margins of normal skin around the visible borders of skin cancers. After tissue is removed from the patient, it is sent to an outside lab where a pathologist will microscopically examine approximately 1% of the surgical margin prior to determining whether the skin cancer is completely removed or not. Disadvantages of this type of surgery when compared to Mohs Micrographic surgery include approximately 8-10% lower cure rates, prolonged waiting/anxiety periods, and increased removal of normal tissue resulting in larger surgical defects and more scarring. The lower cure rates result in the added inconvenience and costs of second or even third surgical procedures.