What are the indications for Mohs micrographic surgery in the treatment of non-melanoma skin cancers?

Mohs micrographic surgery (MMS) is indicated primarily for non-melanoma skin cancers that are high-risk, recurrent, or located in anatomically critical areas where tissue preservation is essential. This includes basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) with aggressive features, poorly defined clinical borders, or those occurring in cosmetically and functionally sensitive sites such as the face, ears, scalp, and genitalia ¹.

Specifically, MMS is recommended for:

• High-risk BCCs and SCCs characterized by size, location, histological subtype, or perineural invasion ¹.
• Recurrent tumors where previous treatment has failed, as MMS allows complete margin assessment and reduces recurrence risk ¹.
• Tumors in areas where maximal tissue conservation is critical to preserve function and appearance, such as the nose, eyelids, lips, ears, and genital skin (Zhu et al., 2021; Zürcher et al., 2024).
• Cutaneous SCCs with aggressive behavior or high-risk features, where MMS provides superior margin control compared to standard excision (Zürcher et al., 2024).

In summary, MMS is preferred for non-melanoma skin cancers that are high-risk, recurrent, or located in anatomically sensitive sites to optimize oncological clearance while minimizing tissue loss and functional impairment. This approach is supported by UK clinical guidelines and reinforced by recent literature emphasizing its role in complex anatomical regions such as the genital area and aggressive SCCs (Zhu et al., 2021; Zürcher et al., 2024) ¹.