A retrospective review of Mohs micrographic surgery trends over more than 10 years in Saudi Arabia

Abstract

Objectives: To review Mohs micrographic surgery (MMS) trends in Saudi Arabia.Mohs micrographic surgery is a precise surgical technique that has been proven to have the highest cure rate with maximum normal tissue preservation. It is the treatment of choice for non-melanoma skin cancer (NMSC), especially the aggressive histopathological forms, and tumors located in high-risk regions or where tissue preservation is a mandate.

Methods: A multicentric retrospective study was performed on patients who underwent MMS between January 2010 and September 2022. The information was extracted from the database of King Saud University Medical City and Prince Sultan Military Medical City in Saudi Arabia.

Results: A total of 70 participants were enrolled in this study. Two-thirds (67%) of the tumors that were treated using MMS were basal-cell carcinomas (BCC), 18.6% were squamous cell carcinomas (SCC), 5.7% were sebaceous carcinoma, 4.3% were dermatofibrosarcoma protuberans (DFSP), and 1.4% were rare tumors such as primary mucinous carcinoma. The most common type of reconstruction used to repair post-MMS defect was primary closure in more than half of the patients followed by secondary intention healing (20%). There were no side effects apart from a hematoma in one patient and wound infection in two patients.

Conclusion: Although MMS is still generally underutilized in Saudi Arabia, its use has increased in the last decade.

Keywords: BCC; DFSP; KSA; MMS; Mohs; Riyadh; SCC; Saudi Arabia; basosquamous carcinoma; micrographic; mucinous carcinoma; retrospective; review; sebaceous carcinoma; skin cancer; surgery.

Figure 1

- Mohs micrographic surgery for pigmented basal-cell carcinomas over the forehead. A) Pigmented basal-cell carcinomas over the forehead. B) Immediate post-first stage of Mohs surgery. C) one-week post-Mohs surgery. D) Two weeks post-Mohs surgery.

Figure 2

- Mohs micrographic surgery for pigmented basal-cell carcinomas over the scalp. A) Pigmented basal-cell carcinomas over the scalp. B) Dermoscopic findings show the absence of a pigment network; there are white, pink, gray, and light-brown stroma, with sharply defined, fine linear, and branching arborizing vessels. C) Immediate first stage post-MMS. D) Coloring the specimen for the frozen section.

Figure 3

- Mohs micrographic surgery for primary mucinous carcinoma. A) Primary mucinous carcinoma of the skin over the left temporal area. B) Dermoscopic findings show a whitish network and light-brown globules with branching serpentine vessels. C) Skin biopsy specimen revealed a dermal mass composed of glands and solid nests of epithelial cells which appear to be floating in copious mucin (Hematoxylin and Eosin staining). D) Complete healing by secondary intention.