Application of Mohs Technique for Squamous Cell Carcinoma of the Nipple

Cutaneous squamous cell carcinoma (SCC) of the nipple areolar complex (NAC) is a rare entity with only a few cases reported in the medical literature. The standard treatment for invasive squamous cell carcinoma includes complete surgical excision of the lesion with postoperative assessment of free margins. Although this skin cancer involves the NAC it should be considered as a completely separate entity from other breast cancers, and therefore may be treated differently than breast cancers involving the NAC. Mohs micrographic surgery is a well-accepted technique for non-melanoma skin cancers (NMSC) with its remarkable precision for tumor eradication and tissue-sparing properties which favor excellent aesthetic outcome. We present a clinical case of 75-year-old Caucasian female who presented to our clinic with a papulose, scaly lesion located at her right nipple that was confirmed to be SCC of the nipple. The patient underwent complete excision of the tumor using Mohs micrographic technique with immediate reconstruction of spared NAC using purse-string suture technique. Free surgical margins were determined intra-operatively by Mohs’s cryosurgery method and further assessed by permanent evaluation. Follow-up was assessed for 3 years without evidence of local recurrence, and high patient satisfaction with the final aesthetic outcome. To the best of our knowledge, this is the first report that validates the feasibility of application of the Mohs technique for nipple SCC excision with immediate nipple reconstruction. Our results suggest that Mohs micrographic surgical technique may be a safe treatment modality for SCC lesions of the NAC allowing superior tissue preservation and enhanced aesthetic results compared to standard wide local excision.