{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:05:25Z","timestamp":1785409525068,"version":"3.56.0"},"reference-count":57,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T00:00:00Z","timestamp":1781913600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","award":["J53D23003260006"],"award-info":[{"award-number":["J53D23003260006"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"award":["J53D23003260006"],"award-info":[{"award-number":["J53D23003260006"]}],"id":[{"id":"https:\/\/ror.org\/019w4f821","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Reflectance confocal microscopy (RCM) enables noninvasive, high-resolution visualization of skin tumors and may improve preoperative margin assessment in nonmelanoma skin cancer (NMSC). However, its impact on surgical outcomes in routine clinical practice remains incompletely defined. Objective: To evaluate surgical outcomes of NMSC managed with systematic preoperative RCM-guided margin assessment, comparing wide local excision (WLE) and Mohs micrographic surgery (MMS). Methods: We conducted a retrospective study of 71 consecutive NMSC treated at a tertiary dermatologic oncology center. All tumors underwent RCM evaluation for diagnosis and preoperative margin mapping. Outcomes included positive margins after WLE, local recurrence, recurrence-free survival, and the number of Mohs stages. Associations were analyzed using Fisher\u2019s exact tests and Firth penalized logistic regression. Results: Among 47 tumors treated with WLE, positive margins occurred in 10.6%. Among 24 MMS cases, 70.8% were cleared in a single stage. Local recurrence occurred in 14.9% of WLE-treated tumors and in none of the MMS-treated tumors (p = 0.087). All recurrences occurred in tumors initially demonstrated positive margins after WLE, despite subsequent re-excision and histologic clearance. In multivariable Firth regression, MMS was associated with a lower risk of recurrence (OR 0.13; 95% CI, 0.008\u20132.10). Conclusions: In this RCM-guided cohort, low margin positivity after WLE and high single-stage clearance in MMS suggest improved surgical accuracy and efficiency. Recurrence was confined to margin-positive tumors, supporting a margin-driven model of tumor control and highlighting RCM as a potential preoperative margin-control strategy.<\/jats:p>","DOI":"10.3390\/diagnostics16121916","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T09:49:55Z","timestamp":1782121795000},"page":"1916","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical Outcomes of Nonmelanoma Skin Cancer Managed with Systematic Preoperative Reflectance Confocal Microscopy-Guided Margin Assessment: A Retrospective Cohort Study Comparing Wide Local Excision and Mohs Micrographic Surgery"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5053-4172","authenticated-orcid":false,"given":"Federico","family":"Venturi","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy"},{"name":"Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Mazzotti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlotta","family":"Baraldi","sequence":"additional","affiliation":[{"name":"Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biagio","family":"Scotti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy"},{"name":"Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Reggiani","sequence":"additional","affiliation":[{"name":"Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6555-6227","authenticated-orcid":false,"given":"Barbara","family":"Corti","sequence":"additional","affiliation":[{"name":"Pathology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3263-4353","authenticated-orcid":false,"given":"Elisabetta","family":"Magnaterra","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy"},{"name":"Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Tassone","sequence":"additional","affiliation":[{"name":"Plastic Surgery Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3186-2861","authenticated-orcid":false,"given":"Emi","family":"Dika","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy"},{"name":"Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"113254","DOI":"10.1016\/j.ejca.2023.113254","article-title":"European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma-update 2023","volume":"192","author":"Peris","year":"2023","journal-title":"Eur. 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