A rationale for the treatment of difficult basal cell and squamous cell carcinomas of the skin.

During a 56-month period, 1,348 patients with either basal cell or squamous cell carcinoma of the skin underwent microscopically controlled excision (Mohs' fresh-tissue technique) by a dermatologic surgeon. Of these 1,348 patients, 394 required various types of wound reconstruction by a plastic surgeon. The average dimensions of these wounds were 5 X 3.5 cm, with a range of 1.5 to 20.0 cm in diameter. There were postoperative complications in 13.9% of the 394 patients. The recurrence rate in these 394 patients, to date, for basal cell carcinoma is 5.2% and for squamous cell carcinoma, 11.9%. The advantages of this treatment arrangement include maximum conservation of normal tissue with provision of more reliable complete tumor excision, optimum time utilization by both dermatologic and plastic surgeons, separation of the responsibility for tumor ablation from that for wound reconstruction, and, in many instances, economic savings. We recommend this method of management for difficult, high-risk basal cell or squamous cell carcinomas.