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Journal of the American Academy of Dermatology
Volume 80, n° 6
pages 1700-1703 (juin 2019)
Doi : 10.1016/j.jaad.2019.01.057
accepted : 25 January 2019
Dermatologic Surgery

Tissue-sparing properties of Mohs micrographic surgery for infiltrative basal cell carcinoma

Marloes S. van Kester, MD, PhD a, b, Jelle J. Goeman, PhD c, Roel E. Genders, MD a, d,
a Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands 
b Department of Dermatology, University Medical Center Groningen, Groningen, The Netherlands 
c Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands 
d Department of Dermatology, Roosevelt Clinic, Leiden, The Netherlands 

Reprint requests: Roel E. Genders, MD, Department of Dermatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.Department of DermatologyLeiden University Medical CenterAlbinusdreef 2Leiden2333 ZAThe Netherlands

Mohs micrographic surgery (MMS) should lead to tissue sparing of healthy skin compared with standard surgical excision because smaller surgical margins are used.


To quantify the tissue-sparing properties of MMS in primary basal cell carcinoma (BCC) with an infiltrative growth pattern.


A prospective study including 256 primary BCCs with an infiltrative growth pattern was performed. Tumor sizes were measured in 2 perpendicular directions. Surface defect areas after MMS were measured. The suspected defect surface area with standard excision using a 5-mm margin was calculated. The primary outcome of this study was the size of the defect surface area spared with MMS compared with the calculated defect surface area with a standard excision.


The median tumor size was 71 mm2, and the median defect size after MMS was 154 mm2. The median defect size calculated for standard surgical excision was 298 mm2. We have shown that MMS of BCC with an infiltrative growth pattern had a 46.4% tissue-sparing effect when compared with standard surgical excision (95% confidence interval, 43.4%-49.1%; P value < .001).


Single-center study design. Lack of a randomized control group for ethical reasons.


A rate of tissue sparing of 46% can be reached by using MMS for primary BCC with an infiltrative growth pattern.

The full text of this article is available in PDF format.

Key words : Mohs micrographic surgery, basal cell carcinoma, tissue sparing

Abbreviations used : BCC, MMS

 Funding sources: None.
 Conflicts of interest: None disclosed.

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