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Background: Perineural invasion of squamous cell carcinoma of the skin causes increased mortality. Objective: We compared survival rates for treatment with Mohs surgery with previous studies of conventional surgery and postoperative radiotherapy. Methods: With a computerized tumor registry we identified 44 cases of squamous cell carcinoma with perineural invasion recurrence, and hazard rates were calculated. Results: Of 44 patients treated with Mohs surgery, three had recurrences. On this basis a survival probability of 88.7% was calculated. Calculation of hazard rate showed highest probability of recurrence 3 to 6 years after Mohs surgery. The clinical characteristics associated with perineural tumor invasion were male sex, size of tumor (>2 cm), forehead location, and previous therapy. Conclusion: When compared with conventional surgical excision and postoperative radiotherapy, early detection and treatment by Mohs surgery of squamous cell carcinoma with perineural invasion result in a much improved survival probability.

Perineural invasion by squamous-cell carcinoma is an ominous sign when discovered by either the pathologist or the chemosurgeon. This report details our experience with seventeen cases of perineural invasion and their successful outcome, using a multidisciplinary approach, including Mohs' surgery.

Eight recurrent basal cell carcinomas and their adjacent scars, which were previously treated with electrodesiccation and curettage, were completely excised by Mohs micrographic surgery and then studied by serial vertical sections. Through the study of an average of 291 serial sections of each recurrent tumor, it was found that four of eight recurrent basal cell carcinomas contained multiple foci of unconnected tumor. It is concluded that iatrogenic multifocality of recurrent basal cell carcinoma previously treated with electrodesiccation and curettage is common. Complete excision of the recurrent basal cell carcinoma and its adjacent scar is supported in view of the high risk of multiple unconnected tumor foci.

A modified method of the fresh-tissue technique of Mohs' surgery is presented with a discussion of its developmental background and advantages. The refinements obviate the need for the chemical fixative. We therefore advocate acceptance of this technique in all cases of cutaneous carcinomas requiring Mohs' surgery.