Superficial Radiation Therapy versus Mohs Micrographic Surgery: A Systematic Review and Meta-Analysis

BACKGROUND There is a lack of studies comparing the effectiveness of superficial radiation therapy (SRT) in treating nonmelanoma skin cancer (NMSC) compared with Mohs micrographic surgery (MMS). OBJECTIVE The goal of this research was to systematically compare the local recurrence rates of NMSC treated with SRT versus MMS. METHODS A literature search was performed using Ovid Medline, Web of Science, Embase, and CINAHL databases from inception to November 13, 2024. Two investigators independently screened and selected case series, cohort studies, chart reviews, and randomized controlled trials reporting outcomes of SRT and/or MMS for NMSC. A meta-analysis was then performed using the random-effects model calculated weighted local recurrence rates for SRT and MMS. RESULTS Nine studies containing 7,809 cases of NMSC treated with SRT and 17 studies containing 10,247 cases of NMSC treated with MMS were included. Local recurrence rates were lower for MMS 1.9% (95% CI, 1.0%–2.9%) compared with SRT 6.3% (95% CI, 3.6%–9.6%). Subgroup analysis identified a difference in local recurrence between MMS and SRT of −12% (95% CI, −19% to −5%; p = .0013). CONCLUSION Systematic review and meta-analysis reveal a lower NMSC local recurrence rate for treatment with MMS compared with SRT.