This large retrospective study evaluated clinical outcomes of high-risk cutaneous squamous cell carcinoma (cSCC) treated with Mohs micrographic surgery alone, without adjuvant therapy. The study analyzed local recurrence, nodal metastasis, and disease-specific death rates. Results demonstrated excellent outcomes for the majority of high-risk cSCC cases treated with Mohs alone, though a subset of tumors with multiple high-risk features showed higher rates of adverse outcomes. The findings support Mohs surgery as definitive treatment for most high-risk cSCC and help identify patients who may benefit from closer surveillance or adjuvant therapy.

Mohs surgery alone achieves excellent local control for the majority of high-risk cSCC, with low recurrence and metastasis rates.

Tumors with multiple concurrent high-risk features (PNI, poor differentiation, immunosuppression) carry higher risk of adverse outcomes even after Mohs.

These outcome data support risk-stratified surveillance protocols: closer follow-up for tumors with multiple high-risk features.