Local Recurrence Rates of Head and Neck Non-Melanomas: A Systematic Review and Meta-Analysis of Wide Local Excision Versus Mohs Micrographic Surgery

Currently, no definitive guidelines exist for selecting between Mohs micrographic surgery (MMS) and wide local excision (WLE) in the treatment of head and neck non-melanoma skin cancers (NMSCs), despite their high recurrence risk and cosmetic sensitivity. In this study, we systematically reviewed and meta-analyzed outcomes from 3,179 patients across nine studies comparing MMS and WLE for NMSCs including BCC, SCC, DFSP, and AFX. We found that MMS significantly reduced local recurrence rates, particularly in SCC, and was consistently associated with superior cosmetic outcomes and smaller surgical defects. Although data on metastasis and long-term survival were limited, MMS showed a trend toward improved control. Notably, recurrence rates were highest in elderly patients treated with WLE, suggesting age as a relevant modifier in surgical decisions. While MMS remains more resource-intensive, our findings support its preferential use in high-risk and cosmetically sensitive head and neck tumors. Future prospective studies are needed to confirm long-term oncologic and cost-effectiveness outcomes.