title: Mohs micrographic surgery for basal cell carcinoma: evaluation of the indication criteria and predictive factors for extensive subclinical spread.
abstract: BACKGROUND
  The incidence of basal cell carcinoma (BCC) is rising and BCC treatment has an important impact on healthcare budget. Mohs micrographic surgery (MMS) has the highest 5-year cure rate but is an expensive technique.
  
  
  OBJECTIVE
  To study the indication criteria for MMS, using a series of 1062 patients treated for facial BCCs between 1998 and 2011.
  
  
  METHODS
  The accuracy of the indication criteria was evaluated by comparing the characteristics of BCC requiring one vs. more than one round of MMS. Predictors for extensive subclinical spread (three or more rounds) were examined using the preoperative patient and all tumour characteristics.
  
  
  RESULTS
  BCCs with a surface > 1 cm(2) and aggressive histology (morphoeaform and micronodular), and a patient age > 80 years are strong predictors for two or more rounds of MMS being required. Extensive subclinical spread was present in recurrent tumours, morphoeaform BCC or BCC with mixed histology.
  
  
  CONCLUSIONS
  We found that tumour size and aggressive histology are the strongest indication criteria for MMS. Recurrence and aggressive histology are predictors for extensive subclinical spread but not for two or more rounds of MMS. Evidence-based indications for MMS are necessary to ensure cost-effective management of BCC.
authors.affiliation: Department of Dermatology, University Hospital Ghent, Ghent, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Hoorens
authors.affiliation: Department of Dermatology, University Hospital Ghent, Ghent, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Batteauw
authors.affiliation: Department of Medical Statistics, University Ghent, Ghent, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: Van Maele
authors.affiliation: Private Practice, Wilrijk, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Lapiere
authors.affiliation: Department of Dermatology, University Hospital Ghent, Ghent, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: Boone
authors.affiliation: Department of Dermatology, University Hospital Ghent, Ghent, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Ongenae
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery*; D005153:Facial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome