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Background: Even though 5-year cure rates are as high as 99% for Mohs micrographic surgery (MMS) of cutaneous carcinomas, theoretically 100% cure rates of unifocal carcinomas should be possible., Objective: To determine why cutaneous malignancies recur locally (persist) after MMS., Methods: A retrospective study of all cutaneous malignancies treated with MMS during a 4-year period at Washington University School of Medicine was made. All lesions that were locally recurrent after previous MMS were analyzed for any possible cause of the recurrence., Results: Of 2,414 cutaneous malignancies treated, 33 (1.4%) were locally recurrent after previous MMS by four different Mohs surgeons and five separate technicians. Technical or interpretation problems that could have accounted for the local recurrence were identified in 77% of the lesions. The mean time to recurrence was 38.5 months, with 20% developing more than 5 years after the initial MMS., Conclusion: MMS local recurrences are rare with procedural errors representing a majority of them. Five-year cure rates for basal cell carcinoma may somewhat overestimate the ultimate cure rate.

A 36-year-old Latin American man with the basal cell nevus syndrome had multiple, soft, hairless, depressed scars of the face, scalp, neck, and back, ranging in size from 0.3 x 0.5 cm to 3.5 x 3.9 cm. These areas had never been treated and previously were sites of basal cell carcinomas that underwent complete spontaneous regression 4-5 years from the date of onset. Pathology of these spontaneously regressed sites was consistent with the criteria established by Curson and Weedon (1979). Type III transepithelial elimination was demonstrated for a basal cell carcinoma. Type III transepithelial elimination may play a role in the spontaneous regression of basal cell carcinomas.

Two patients developed new primary basal cell carcinomas (BCCs) in skin flaps used to reconstruct wounds that followed an earlier primary BCC and a recurrent BCC treated by Mohs micrographic surgery. Criteria for distinguishing a new primary BCC arising in a skin flap or full-thickness skin graft at a previous treatment site for BCC from a truly recurrent BCC are presented. The distinction between a new primary BCC and true tumor recurrence is important for accurate clinical assessment and may have a dramatic impact on the type of subsequent treatment. In addition, there may be less medicolegal liability in the case of a new primary BCC arising at the site of a previously treated BCC than for a BCC that is determined to be recurrent.

Aromatic retinoids have been shown to be useful in the management of various genodermatoses, including nevoid basal cell carcinoma syndrome (NBCCS). A patient with this condition was treated by combined etretinate and surgical therapy. Over the course of 12 months, the patient was placed on oral etretinate therapy, with a dosage of 1 mg/kg/day for 3 months, and 0.5 mg/kg/day for 9 months. In the first period, notable tumor reduction was observed in the larger tumors. Complete clinical regression was seen in only 26% of BCCs with an overall tumor size of less than 1 cm in diameter. In the second period, no tumor changes were observed, but no new tumors appeared. Surgical excisions of the remaining tumors were carried out 3 months after the end of the etretinate treatment, with excellent results and no recurrences after 6 months of follow-up. Treatment with etretinate permits a less aggressive surgical excision and recurrence rate than surgical excision alone.

The case of a young, mentally retarded woman with the nevoid basal-cell carcinoma syndrome is presented in whom about 150 basal-cell carcinomas on the face were treated simultaneously be curettage and electrodesiccation with the patient under general anesthesia. Such a method is excellent for eradicating numerous carcinomas rapidly, effectively, and at once, especially when cooperation of the patient is not optimal.