Initial Mohs surgery followed by planned surgical resection of massive cutaneous carcinomas of the head and neck.

OBJECTIVE: To review our experience with Mohs excision of massive cutaneous carcinomas for peripheral margin control, followed by planned definitive resection of the deeply invasive component of the carcinoma.

STUDY DESIGN: Retrospective review.

METHODS: All cases of massive (at least 10 cm in dimension) cutaneous carcinomas treated by the technique outlined by Yadranko Ducic from 1998-2006.

RESULTS: A total of 28 cases (7 squamous cell carcinomas, 14 basal cell carcinomas, 7 basosquamous carcinomas) were treated in this manner. Average maximal tumor dimension was 12.7 cm with a range of 10-21 cm. None of the patients recurred at the peripheral margin at an average follow-up of 3.2 years. There were a total of 7 local recurrences (5 squamous cell carcinoma and 2 basal cell carcinoma). All recurrences occurred within the deep resection bed.

CONCLUSIONS: The technique appears to be an excellent means of treatment of massive, neglected, and deeply invasive cutaneous carcinomas of the face and neck. It allows for more precise margin control than can be afforded by surgical pathology, decreases length of anesthesia, and enables the surgeon to more accurately plan the required reconstruction to review with the patient preoperatively.