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Stuart H. Bentkover, MD; Donald M. Grande, MD; Henry Soto, MD; Beth A. Kozlicak, RN, RNC; Donna Guillaume, RN; Sheila Girouard, RN

Arch Facial Plast Surg. 2002;4:114-119.

Objectives  To compare a rapid, cross-sectional frozen-section technique with Mohs micrographic surgery, using recurrence rate and cost of treatment for excision of basal cell carcinoma as indicators to validate our indications for Mohs surgery.

Design  Retrospective study of 557 head and neck basal cell carcinomas excised over 10 years.

Main Outcome Measures  Recurrence rates; tumor comparisons by size, location, and subtype; a life table, and a patient satisfaction survey.

Results  Recurrence rate for the cross-sectional technique was 2.1% at 5 years. Recurrent tumors had an average diameter of 1.56 cm (vs 1.04 cm for nonrecurrent tumors). Recurrences were in the cheek (30%), nose (20%), temple (20%), forehead/brow (10%), conchal bowl (10%), and postauricular crease (10%). Recurrences were nodular cystic (40%), micronodular (20%), multifocal (10%), and infiltrating (30%). A total of 86.6% of patients surveyed rated the aesthetic outcome of their surgery favorably. The cost compared with the cost of Mohs excision varied depending on the Current Procedural Terminology coding technique.

Conclusions  Cross-sectional frozen-section recurrence rates can compare favorably with Mohs micrographic surgery. The cross-sectional frozen-section technique generated a cost savings over Mohs surgery that may not hold true for all practice settings. Margin size did not adversely affect aesthetic results. Loupe magnification x2.5 is important in our technique. We also offer a useful definition for recurrence.

From the Fallon Clinic (Dr Bentkover and Mss Kozlicak, Guillaume, and Girouard); Donald M. Grande & Associates (Dr Grande); and the Department of Pathology, Saint Vincent Hospital (Dr Soto), Worcester, Mass. Dr Bentkover is now with the Bentkover Facial Plastic Surgery & Laser Center, Worcester.

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