Same-Day Biopsy During Mohs Surgery for Non-Melanoma Skin Cancer: An Exploratory Analysis

Abstract

Background Non-melanoma skin cancer (NMSC) affects over 3 million Americans annually, and the traditional two-visit pathway can result in substantial delays between diagnostic biopsy and definitive treatment. During Mohs surgery visits, clinicians may identify other clinically suspicious lesions separate from the tumor already scheduled for treatment, creating an opportunity for same-day biopsy rather than delayed evaluation. Although delays may not affect mortality, prior studies suggest that longer intervals to Mohs surgery may be associated with larger defects at the time of excision and, for higher-grade squamous cell carcinoma (SCC), tumor growth or progression.

Objective To characterize the diagnostic yield and clinical features of other clinically suspicious lesions identified during same-day Mohs surgery visits and to assess the feasibility of same-day biopsy as an opportunistic workflow in NMSC care.

Methods A retrospective analysis was performed of NMSC patients who underwent same-day biopsy and subsequent Mohs surgery at a single academic medical center Mohs unit (January 2022 to June 2023). Descriptive statistics were conducted to characterize demographics, diagnoses, and treatment decisions for the biopsied lesions.

Results A total of 140 lesions were biopsied in 116 patients. Of these lesions, 101 (72.1%) were NMSC, including 65/140 (46.4%) pathology-confirmed basal cell carcinomas (BCC) and 36/140 (25.7%) SCC. Of the 36 SCCs, 20 (55%) were located in medium-risk, 10 (29%) in high-risk, and 6 (16%) in low-risk anatomic areas per Mohs appropriate use criteria (AUC). All 101 lesions diagnosed as NMSC were excised on the same day as biopsy.

Conclusions Additional lesions identified during scheduled Mohs visits were frequently malignant. Same-day biopsy enabled immediate confirmation and definitive treatment for all NMSC lesions in this cohort, supporting the feasibility of integrating same-day biopsy into the Mohs workflow. Same-day biopsy may facilitate more efficient care pathways and reduce missed or delayed NMSC diagnoses; however, longitudinal outcomes require further investigation.