WEDNESDAY, Dec. 13, 2023 -- For patients with nail unit cutaneous squamous cell carcinoma (cSCC), Mohs micrographic surgery (MMS) results in a localized recurrence rate (LRR) of 1.7 percent, according to a research letter published online Dec. 1 in the Journal of the American Academy of Dermatology.

Surya A. Veerabagu, M.D., from the University of New Mexico in Albuquerque, and colleagues reported LRRs for the largest single-institutional cohort of MMS-treated nail unit cSCC. Cases included invasive and in situ cSCC (cSCCis) localized to the nail unit; 101 patients with 117 distinct nail unit cSCC and cSCCis were included in the analysis.

The researchers found that during a mean follow-up of 2.5 years, the LRR was 1.7 percent (2/117). Dermatologists identified both local recurrences, which occurred in immunocompromised transplant recipients (bone marrow and renal). The Kaplan-Meier LRRs at one and five years were 1.00 and 2.12 percent, respectively. Reconstructions were performed by a Mohs surgeon and plastic surgeon in 53.8 and 46.2 percent of cases, respectively. Full-thickness skin graft, second intention healing, and amputation with local volar flap were the most common reconstructions (34.2, 27.4, and 17.1 percent, respectively). For patients undergoing amputation, MMS helped ascertain soft tissue and/or bony involvement, which aided with the decision to perform partial or full amputation; LRR in this subgroup was 0 percent.

"This large retrospective cohort supports the growing use of MMS to lower LRR for nail unit cSCC," the authors write.