Prospective Observational Study on the Use of Confocal Microscopy in Defining Pre-Operative Surgical Margins of Non Melanoma Skin Cancers of the Head and Neck Treated With Mohs Surgery

MMS is considered the gold standard for treating skin cancers at high risk of recurrence, particularly in functionally or cos-metically sensitive areas, due to its high cure rates and precision in margin control, while preserving healthy tissue. However, MMS has certain limitations, such as being a time-intensive procedure requiring the involvement of multiple professionals(physicians and technicians). In this regard, presurgical evaluation of tumor margins using noninvasive optical diagnostic methods such as RCM may aid in better margin assessment, potentially reducing the number of MMS stages and the overall duration of the procedure. Tis prospective observational study evaluated the use of RCM and VDS in defining preoperative surgical margins for high-risk NMSCs of the head and neck treated with MMS. Te study was conducted at the Oncologic Dermatology Unit of IRCCS Azienda Ospedaliero Universitaria of Bologna from January 2018 to June 2024. Based on the treatment received, the patients were divided into 2 groups: patients treated with RCM-assisted MMS (36) and patients treated with VDS-assisted-MMS (302). Mean age at diagnosis was lower in Group 1 which also required fewer MMS stages to achieve clear margins (p<0.001) compared to Group 2. The integration of RCM in preoperative margin assessment significantly reduces MMS stages, improves surgical efficiency, and enhances patient management, especially in high-risk, complex NMSC cases.