A case series of Mohs micrographic surgery

Basal cell carcinoma (BCC) is the most common skin malignancy, often requiring precise excision to minimize recurrence and preserve cosmesis, especially in facial regions. While Mohs micrographic surgery (MMS) offers the highest cure rates through intraoperative histological margin control and the preservation of healthy tissue, its precision can be further enhanced by dermoscopy to guide targeted excision. In a recent case series at a tertiary care center in South India, six patients with histologically confirmed BCC were treated using dermoscopy-assisted MMS. Pre-operative evaluation included dermoscopy alongside hematological and serological workups. During the standardized MMS procedure, lesions were excised with 1-mm margins using a tangential technique, and frozen sections were evaluated to guide any subsequent excisions. Ultimately, all patients achieved complete tumor clearance within one to three Mohs layers. The use of dermoscopy significantly improved pre-operative margin delineation, which helped reduce the number of excision layers required. Following clearance, reconstruction techniques—including bilobed flaps, advancement flaps, and primary closure—were selected based on the defect’s size and location, yielding excellent functional and esthetic outcomes. These findings highlight that dermoscopy-guided MMS is highly effective in achieving tumor-free margins with optimal cosmetic results, reinforcing MMS as the gold standard for managing BCCs in cosmetically sensitive areas due to its tissue conservation, low recurrence rates, and superior post-operative satisfaction.