Neoadjuvant Therapy in Mohs Surgery: A Scoping Review of the Literature

BACKGROUND: Neoadjuvant therapies are increasingly used before Mohs micrographic surgery (MMS) to shrink tumors and reduce defect size, tumor and surgical invasiveness, and reconstruction complexity. Data on neoadjuvant agents used before MMS, their efficacy, and tolerability are limited. OBJECTIVE: The aim of this study was to analyze the literature regarding neoadjuvant therapies in MMS, protocols, outcomes, and tolerability. METHODS: A scoping review of PubMed, Embase, and Scopus was conducted on July 8th, 2025. Articles related to systemic or local chemotherapeutic and immunotherapeutic agents used neoadjuvantly in MMS were included. RESULTS: Thirty-three studies, including 303 patients, met inclusion criteria. Reports of neoadjuvant vismodegib, sonidegib, and imiquimod in basal cell carcinoma support reduction of the final defect and organ preservation. Reports of neoadjuvant imatinib for dermatofibrosarcoma protuberans show reduction in tumor size. Case reports demonstrated benefits from neoadjuvant talimogene laherparepvec in squamous cell carcinoma and pembrolizumab for desmoplastic melanoma and sebaceous carcinoma. CONCLUSIONS: Neoadjuvant therapy can be used before MMS to shrink tumors, decrease surgical defects, and improve cosmetic, functional, and disease outcomes. It should be considered for locally advanced tumors or when preservation of tissue and anatomic function is critical. Larger studies are needed to confirm whether neoadjuvant therapies improve surgical and cosmetic outcomes and reduce recurrence and metastasis.