5 Years, layer by layer: mohs micrographic surgery insights from Indonesia cancer center dharmais cancer hospital -

Abstract

Abstract:

Background: Mohs micrographic surgery (MMS) is the gold standard for treating high-risk non-melanoma skin cancer (NMSC). However, epidemiological data on MMS in Indonesia remain limited. This study aims to evaluate MMS use, tumor characteristics, and surgical outcomes at a single center in Indonesia.

Methods: A retrospective review of 83 MMS cases at Dharmais Cancer Hospital (2020–2024) was conducted. Data on demographics, tumor characteristics, and surgical outcomes were analyzed. Tumor locations were classified into high-risk (H area), moderate-risk (M area), and low-risk (L area) anatomical zones.

Results: Most tumors were located in the H area (57.8%). Basal cell carcinoma (BCC) was the most common diagnosis (79.5%), with infiltrative BCC as the predominant subtype (41.0%). A surgical margin of ≥3 mm was significantly associated with achieving tumor clearance in a single stage (p = 0.018). Multiple-stage MMS was required in 15.0% of cases. Defect closure was primarily performed using grafts or flaps (69.9%), with dermatologists performing most reconstructions (83.1%).

Conclusion: MMS is effective for treating high-risk NMSC in Indonesia, with findings comparable to global data. The study highlights the importance of appropriate surgical margins and the need for further research, particularly in Asian countries. Establishing a national skin cancer registry would enhance future epidemiological studies.

Keywords: Mohs micrographic surgery, basal cell carcinoma, surgical margin, H area, Indonesia