Cancer of the oral cavity and Mohs surgery

Malignant tumors of the oral cavity make up approximately 4% of all cancers occuring in men and 2% in women. In spite of this relatively small incidence, the functional and cosmetic disabilities resulting from this disease produce a profound impact on those stricken. Although the oral cavity is one of the most accessible areas to inspection and palpation, most patients developing oral cavity cancer present with advanced disease. Regional metastases are present in approximately 30% of these patients. A number of therapeutic modalities are available for management of cancer of the oral cavity. The most important include surgical excision, radiation therapy, chemotherapy, or a combination of two or more of these modalities. Surgery and radiotherapy are equally successful in controlling smaller tumors, but advanced tumors are best treated with a combination of surgery and irradiation with or without the addition of chemotherapy. Although combined therapy continues to become more common, it has had little impact on survival rates. Most patients dying of oral cavity cancer die of local regional disease. It is this group of patients that will benefit from newer surgical approaches that can provide an opportunity to increase control of local disease. We believe that an interdisciplinary approach combining the skills of the head and neck oncologic surgeon and the Mohs surgeon may provide a more effective method of controlling oral cancer, while at the same time lessening the functional and cosmetic deformities that frequently result following surgical treatment of this disease. Complete microscopic analysis of all surgical margins (as opposed to random analysis of isolated margins) theoretically should ensure better local control of cancers involving the oral cavity.