Resource Use and Cost Comparison of Mohs Micrographic Surgery vs Traditional Surgery for High-risk Facial Basal Cell Carcinoma.

High-risk facial basal cell carcinomas are preferably treated with Mohs micrographic surgery, but despite its documented benefits, it remains underused in Sweden. The aim of this study was to evaluate healthcare resource utilization and direct costs for patients with high-risk facial basal cell carcinomas treated with Mohs micrographic surgery compared with traditional surgical excision. In this retrospective registry study, all patients undergoing Mohs micrographic surgery or surgical excision at Sahlgrenska University Hospital between 2020 and 2024 were included, supplemented by regional healthcare data from the Vega registry, to assess long-term healthcare use up to 10 years after primary treatment. Mohs micrographic surgery was associated with higher initial costs than surgical excision but a slower accumulation of costs over time. Patients initially treated with surgical excision who later required Mohs micrographic surgery incurred the highest total costs, often after multiple prior procedures. These findings indicate that although Mohs micrographic surgery is costlier initially, early access prevents the substantial downstream costs associated with treatment failure. Primary Mohs micrographic surgery is a cost-efficient strategy for high-risk facial basal cell carcinomas and should be used more frequently in order to enable better utilization of resources and improved outcomes for the patient.