title: Surgical excision versus Mohs' micrographic surgery for basal cell carcinoma of the face: A randomised clinical trial with 10 year follow-up.
abstract: BACKGROUND
  Basal cell carcinoma (BCC) is the most common form of cancer among Caucasians and its incidence continues to rise. Surgical excision (SE) is considered standard treatment, though randomised trials with long-term follow-up are rare. We now report the long-term results of a randomised trial comparing surgical excision with Mohs' micrographic surgery (MMS) for facial BCC.
  
  
  METHODS
  408 facial, high risk (diameter at least 1cm, H-zone location or aggressive histological subtype) primary BCCs (pBCCs) and 204 facial recurrent BCCs (rBCCs) were randomly allocated to treatment with either SE or MMS between 5th October 1999 and 27th February 2002. The primary outcome was recurrence of carcinoma. A modified intention to treat analysis was performed.
  
  
  RESULTS
  For primary BCC, the 10-year cumulative probabilities of recurrence were 4.4% after MMS and 12.2% after SE (Log-rank test χ(2) 2.704, p=0.100). For recurrent BCC, cumulative 10-year recurrence probabilities were 3.9% and 13.5% for MMS and SE, respectively (Log-rank χ(2) 5.166, p=0.023). A substantial proportion of recurrences occurred after more than 5years post-treatment: 56% for pBCC and 14% for rBCC.
  
  
  CONCLUSIONS
  Fewer recurrences occurred after treatment of high risk facial BCC with MMS compared to treatment with SE. The proportion of recurrences occurring more than 5years post-treatment was especially high for pBCC, stressing the need for long-term follow-up in patients with high risk facial pBCC.
authors.affiliation: Maastricht University FHML, P.O. Box 616, 6200 MD Maastricht, Netherlands.
authors.forename: Eva
authors.initials: E
authors.lastname: van Loo
authors.affiliation: Department of Dermatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, Netherlands.
authors.forename: Klara
authors.initials: K
authors.lastname: Mosterd
authors.affiliation: Department of Dermatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, Netherlands; MohsA, Expertise Centre for Mohs Micrographic Surgery, Buitenlust 35, 5803 AZ Venray, Netherlands.
authors.forename: Gertruud A M
authors.initials: GA
authors.lastname: Krekels
authors.affiliation: Department of Dermatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, Netherlands.
authors.forename: Marieke H
authors.initials: MH
authors.lastname: Roozeboom
authors.affiliation: Department of Dermatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, Netherlands; Mohsklinieken, Winston Churchilllaan 85, 5623 KW Eindhoven, Netherlands.
authors.forename: Judith U
authors.initials: JU
authors.lastname: Ostertag
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, Netherlands.
authors.forename: Carmen D
authors.initials: CD
authors.lastname: Dirksen
authors.affiliation: Department of Dermatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, Netherlands; Department of Dermatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, Netherlands.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Steijlen
authors.affiliation: Department of Dermatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, Netherlands; Department of Dermatology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, Netherlands.
authors.forename: H A Martino
authors.initials: HA
authors.lastname: Neumann
authors.affiliation: Department of Epidemiology, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, Netherlands.
authors.forename: Patty J
authors.initials: PJ
authors.lastname: Nelemans
authors.affiliation: Department of Dermatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, Netherlands; Department of Dermatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, Netherlands. Electronic address: n.kelleners.smeets@mumc.nl.
authors.forename: Nicole W J
authors.initials: NW
authors.lastname: Kelleners-Smeets
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000401:mortality / Q000601:surgery*; D005153:Facial Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery / Q000379:methods* / Q000401:mortality; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Basal cell carcinoma; Facial; Mohs surgery; Randomised controlled trial; Surgical excision