10 Years of Mohs Micrographic Surgery in Denmark: Results from a Nationwide Cohort
DOI:
https://doi.org/10.2340/actadv.v105.41118Keywords:
basal cell carcinoma, epidemiology, Mohs micrographic surgery, recurrence rate, registryAbstract
Basal cell carcinoma is the most common skin malignancy and constitutes a burden for patients and society. Mohs micrographic surgery is a recommended treatment for high-risk basal cell carcinoma, but long-term outcomes of Mohs micrographic surgery in Denmark are unknown. This study aimed to estimate the 5-year recurrence rate of basal cell carcinoma following Mohs micrographic surgery, and to investigate patient and procedure characteristics since the introduction of the procedure in Denmark. The Danish Registry for Mohs Surgery was established and all Mohs micrographic surgery cases nationwide from January 2012 to December 2022 were included. A total of 1,774 patients were included in the cohort, and 2,203 high-risk basal cell carcinomas were treated using Mohs micrographic surgery techniques. The overall 5-year recurrence of basal cell carcinoma following Mohs micrographic surgery was 3.8% (95% CI 2.8–5.0), 3.1% (95% CI 2.1–4.7) for primary basal cell carcinomas, and 5.3% (95% CI 3.6–7.8) for recurrent basal cell carcinomas. The primary basal cell carcinomas showed a tendency towards lower recurrence rates and better surgical outcomes than recurrent basal cell carcinomas, although not significantly. The recurrence rate estimates correspond to international levels, supporting Mohs micrographic surgery as a treatment option for high-risk basal cell carcinomas in Danish dermatological practice. The newly established patient registry serves as a cohort for future research in this field.
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Miller DL, Weinstock MA. Nonmelanoma skin cancer in the United States: Incidence. J Am Acad Dermatol 1994; 30: 774-778.
https://doi.org/10.1016/S0190-9622(08)81509-5 DOI: https://doi.org/10.1016/S0190-9622(08)81509-5
Bentzen J, Kjellberg J, Thorgaard C, Engholm G, Phillip A, Storm HH. Costs of illness for melanoma and nonmelanoma skin cancer in Denmark. Eur J Cancer Prev 2013; 22: 569-576.
https://doi.org/10.1097/CEJ.0b013e328360150c DOI: https://doi.org/10.1097/CEJ.0b013e328360150c
Housman TS, Feldman SR, Williford PM, Fleischer AB, Goldman ND, Acostamadiedo JM, et al. Skin cancer is among the most costly of all cancers to treat for the Medicare population. J Am Acad Dermatol 2003; 48: 425-429.
https://doi.org/10.1067/mjd.2003.186 DOI: https://doi.org/10.1067/mjd.2003.186
Madan V, Hoban P, Strange RC, Fryer AA, Lear JT. Genetics and risk factors for basal cell carcinoma. Br J Dermatol 2006; 154: 5-7.
https://doi.org/10.1111/j.1365-2133.2006.07229.x DOI: https://doi.org/10.1111/j.1365-2133.2006.07229.x
Preston DS, Stern RS. Nonmelanoma Cancers of the Skin. New Engl J Med 1992; 327: 1649-1662.
https://doi.org/10.1056/NEJM199212033272307 DOI: https://doi.org/10.1056/NEJM199212033272307
Basset-Seguin N, Herms F. Update on the management of basal cell carcinoma. Acta Derm Venereol 2020; 100: 284-290.
https://doi.org/10.2340/00015555-3495 DOI: https://doi.org/10.2340/00015555-3495
Peris K, Concetta M, Garbe C, Kaufmann R, Bastholt L, Seguin N European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC). European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma-update 2023. Eur J Cancer 2023: 192: 113254
https://doi.org/10.1016/j.ejca.2023.113254 DOI: https://doi.org/10.1016/j.ejca.2023.113254
Puig S, Berrocal Management of high-risk and advanced basal cell carcinoma. Clin Transl Oncol 2015 Jul; 17: 497-503.
https://doi.org/10.1007/s12094-014-1272-9 DOI: https://doi.org/10.1007/s12094-014-1272-9
Shriner DL, McCoy DK, Goldberg DJ, Wagner J. Mohs micrographic surgery. J Am Acad Dermatol 1998; 39: 79-97.
https://doi.org/10.1016/S0190-9622(98)70405-0 DOI: https://doi.org/10.1016/S0190-9622(98)70405-0
Muller FM, Dawe RS, Moseley H, Fleming CJ. Randomized comparison of Mohs micrographic surgery and surgical excision for small nodular basal cell carcinoma: tissue-sparing outcome. Dermatol Surg 2009; 35: 1349-1354.
https://doi.org/10.1111/j.1524-4725.2009.01240.x DOI: https://doi.org/10.1111/j.1524-4725.2009.01240.x
van Kester MS, Goeman JJ, Genders RE. Tissue-sparing properties of Mohs micrographic surgery for infiltrative basal cell carcinoma. J Am Acad Dermatol 2019; 80: 1700-1703.
https://doi.org/10.1016/j.jaad.2019.01.057 DOI: https://doi.org/10.1016/j.jaad.2019.01.057
Smeets NWJ, Krekels GAM, Ostertag JU, Essers BAB, Dirksen CD, Nieman FHM, et al. Surgical excision vs Mohs' micrographic surgery for basal-cell carcinoma of the face: randomised controlled trial. Lancet 2004; 364: 1766-1772.
https://doi.org/10.1016/S0140-6736(04)17399-6 DOI: https://doi.org/10.1016/S0140-6736(04)17399-6
Gniadecki R, Glud M, Mortensen K, Bang B, Biskup E, Omland SH aukali. Favourable results of Mohs micrographic surgery for basal cell carcinoma. Dan Med J 2015; 62: A5171.
Paoli J, Daryoni S, Wennberg AM, Mölne L, Gillstedt M, Miocic M, et al. 5-year recurrence rates of Mohs micrographic surgery for aggressive and recurrent facial basal cell carcinoma. Acta Derm Venereol 2011; 91: 689-693.
https://doi.org/10.2340/00015555-1134 DOI: https://doi.org/10.2340/00015555-1134
Smeets NWJ, Kuijpers DIM, Nelemans P, Ostertag JU, Verhaegh MEJM, Krekels GAM, et al. Mohs' micrographic surgery for treatment of basal cell carcinoma of the face-results of a retrospective study and review of the literature. Br J Dermatol 2004; 151: 141-147.
https://doi.org/10.1111/j.1365-2133.2004.06047.x DOI: https://doi.org/10.1111/j.1365-2133.2004.06047.x
Rowe DE, Carroll RH, Day CL. Long‐term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow‐up. J Dermatol Surg Oncol 1989; 15: 315-328.
https://doi.org/10.1111/j.1524-4725.1989.tb03166.x DOI: https://doi.org/10.1111/j.1524-4725.1989.tb03166.x
Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R, Adelaide F, et al. Basal cell carcinoma treated with Mohs surgery in Australia II. Outcome at 5-year follow-up. J Am Acad Dermatol 2005; 53: 452-457.
https://doi.org/10.1016/j.jaad.2005.04.087 DOI: https://doi.org/10.1016/j.jaad.2005.04.087
Tomás-Velázquez A, Sanmartin-Jiménez O, Garcés JR, Rodríguez-Prieto MA, Ruiz-Salas V, Eusebio-Murillo E De, et al. Risk factors and rate of recurrence after mohs surgery in basal cell and squamous cell carcinomas: a nationwide prospective cohort (REGESMOHS, Spanish Registry of Mohs Surgery). Acta Derm Venereol 2021; 101: 544.
https://doi.org/10.2340/actadv.v101.544 DOI: https://doi.org/10.2340/actadv.v101.544
Dr Tedros Adhanom Ghebreyesus. World Health Statistics 2023. Monitoring health for the SDGs Sustainable Development Goals. 2023; 119.
Helsing P, Gjersvik P, Tarstedt M. Treatment of basal cell carcinoma in Scandinavia: evidence or eminence based? Int J Dermatol 2015; 54: 1030-1033.
https://doi.org/10.1111/ijd.12599 DOI: https://doi.org/10.1111/ijd.12599
Cook J, Zitelli JA. Mohs micrographic surgery: A cost analysis. J Am Acad Dermatol 1998; 39: 698-703.
https://doi.org/10.1016/S0190-9622(98)70041-6 DOI: https://doi.org/10.1016/S0190-9622(98)70041-6
Sebaratnam DF, Choy B, Lee M, Paver R, Fernández Peñas P. Direct cost-analysis of Mohs micrographic surgery and traditional excision for basal cell carcinoma at initial margin clearance. Dermatol Surg 2016; 42: 633-638.
https://doi.org/10.1097/DSS.0000000000000756 DOI: https://doi.org/10.1097/DSS.0000000000000756
Van Loo E, Mosterd K, Krekels GAM, Roozeboom MH, Ostertag JU, Dirksen CD, et al. Clinical trial surgical excision versus Mohs' micrographic surgery for basal cell carcinoma of the face: A randomised clinical trial with 10 year follow-up. Eur J Cancer 2014; 50: 3011-3020.
https://doi.org/10.1016/j.ejca.2014.08.018 DOI: https://doi.org/10.1016/j.ejca.2014.08.018
Alsaif A, Hayre A, Karam M, Rahman S, Abdul Z, Matteucci P. Mohs micrographic surgery versus standard excision for basal cell carcinoma in the head and neck: systematic review and meta-analysis. Cureus 2021; 13: 19981.
https://doi.org/10.7759/cureus.19981 DOI: https://doi.org/10.7759/cureus.19981
Nolan Id GS, Kiely AL, Totty JP, Wormald JCR, Wade RG, Arbyn Id M, et al. Incomplete surgical excision of keratinocyte skin cancers: a systematic review and meta-analysis Br J Dermatol 2021; 184: 1033-1044.
https://doi.org/10.1111/bjd.19660 DOI: https://doi.org/10.1111/bjd.19660
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Copyright (c) 2025 Yuki M.F. Andersen, Katrine Karmisholt, Trine Høgsberg, Mia-Louise Nielsen, Amanda Brosbøl, Sascha Stave, Louise Schøsler, Silje Omland, Christine Aarenstrup Daugaard, Martin Glud

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