This systematic review and meta-analysis compared recurrence rates of high-risk keratinocyte carcinomas (BCC and SCC) treated with complete margin assessment (CMA, as in Mohs micrographic surgery) versus standard excision with sectional assessment (SA). The analysis demonstrated significantly lower recurrence rates with CMA across all high-risk tumor categories, reinforcing the rationale for Mohs surgery in managing high-risk skin cancers. The study provides Level 1 evidence supporting NCCN guidelines recommending CMA for keratinocyte carcinomas with high-risk features.

Complete margin assessment (Mohs) yields significantly lower recurrence rates than sectional assessment for high-risk keratinocyte carcinomas.

This meta-analysis provides Level 1 evidence supporting NCCN guidelines for CMA in high-risk BCC and SCC.

The recurrence benefit of CMA is consistent across all high-risk tumor subtypes and anatomical locations.