Mohs micrographic surgery in rare cutaneous tumors: a retrospective study at a Brazilian tertiary university hospital

An Bras Dermatol. 2023 Jan-Feb;98(1):36-46. doi: 10.1016/j.abd.2022.01.009. Epub 2022 Nov 8.


Background: Mohs micrographic surgery is an established technique in the treatment of cutaneous neoplasms. It offers higher cure rates and the main indications are non-melanoma malignant skin tumors. Few studies have been performed on the treatment of rare tumors through this technique.

Objective: To study rare skin tumors and rare variants of basal cell carcinoma and squamous cell carcinoma submitted to Mohs micrographic surgery in a tertiary service in relation to frequency, disease-free evolution, and applicability of this surgical procedure for this group of tumors.

Methods: This was a retrospective observational study including rare skin tumors and less common variants of basal cell carcinoma and squamous cell carcinoma treated using Mohs micrographic surgery, between October 2008 and April 2021.

Results: During the study period, 437 tumors were treated using Mohs micrographic surgery, and 22 (5%) rare skin tumors were selected. The tumors comprised three dermatofibrosarcomas protuberans, two atypical fibroxanthomas, two spiradenomas, two hypercellular fibrohistiocytomas, one primary cutaneous adenocarcinoma, one trichoblastoma, one porocarcinoma, one chondroid syringoma, one cutaneous angiosarcoma, one Merkel cell carcinoma, and one sebaceous carcinoma. Six other cases of rare basal cell carcinoma variants with trichoepitheliomatous differentiation, metatypical basal cell carcinoma, and clear cell squamous cell carcinoma were included. There were no cases of recurrence after an average of six years of follow-up.

Study limitations: This is a retrospective study on rare neoplasms carried out in a single referral center, and this surgical technique isn't widely available in the public service.

Conclusion: This retrospective case series showed that Mohs micrographic surgery is an appropriate treatment for rare skin tumors. They corresponded to 5% of the tumors treated by the technique during a 12-year-period, with no recurrences identified.

Keywords: Acrospiroma; Adenocarcinoma; Carcinoma, Merkel cell; Dermatofibrosarcoma; Mohs surgery; Skin neoplasms.

Publication types

  • Observational Study

MeSH terms

  • Brazil
  • Carcinoma, Basal Cell* / pathology
  • Carcinoma, Basal Cell* / surgery
  • Carcinoma, Squamous Cell* / pathology
  • Carcinoma, Squamous Cell* / surgery
  • Humans
  • Mohs Surgery / methods
  • Neoplasm Recurrence, Local / surgery
  • Retrospective Studies
  • Skin Neoplasms* / pathology
  • Skin Neoplasms* / surgery
  • Sweat Gland Neoplasms* / surgery
  • Tertiary Care Centers