Mohs micrographic surgery: a review of indications, technique, outcomes, and considerations

Abstract

Mohs micrographic surgery is a specialized form of skin cancer surgery that has the highest cure rates for several cutaneous malignancies. Certain skin cancers can have small extensions or “roots” that may be missed if an excised tumor is serially cross-sectioned in a “bread-loaf” fashion, commonly performed on excision specimens. The method of Mohs micrographic surgery is unique in that the dermatologist (Mohs surgeon) acts as both surgeon and pathologist, from the preoperative considerations until the reconstruction. Since Dr. Mohs’s initial work in the 1930s, the practice of Mohs micrographic surgery has become increasingly widespread among the dermatologic surgery community worldwide and is considered the treatment of choice for many common and uncommon cutaneous neoplasms. Mohs micrographic surgery spares the maximal amount of normal tissue and is a safe procedure with very few complications, most of them managed by Mohs surgeons in their offices. Mohs micrographic surgery is the standard of care for high risks basal cell carcinomas and cutaneous squamous cell carcinoma and is commonly and increasingly used for melanoma and other rare tumors with superior cure rates. This review better familiarizes the dermatologists with the technique, explains the difference between Mohs micrographic surgery and wide local excision, and discusses its main indications.

Clinicopathological factors influencing the number of stages of Mohs surgery for basal cell carcinoma

“…Mohs Micrographic Surgery (MMS) is a technique that allows intraoperative microscopic control of the surgical margins, being a good treatment option when tissue conservation is required for aesthetic or functional reasons. 1 Moreover, Basal Cell Carcinomas (BCCs) located in high-risk areas are preferably treated by MMS. 2 A recent Italian study evaluated the recurrence rate of head and neck high-risk BCCs comparing MMS with conventional surgical excision and confirmed the trend already reported in the literature that MMS is the best treatment option for high-risk BCCs arising in the head and neck region or being recurrent, with a recurrence rate of 3.1% with MMS versus 14% with traditional surgery (p < 0.00001).…”

Recurrence rate of basal cell carcinoma among different micrographic surgery techniques: systematic review with meta‐analysis

“…6,7 The tissue is sectioned vertically at random intervals of 2-4 mm to assess the presence of a tumour in the surgical margin. 6,7 However, these sections represent a sample of less than 1% of the surgical margins, and sampling errors can occur if the interval performed between the sections covers a subclinical extent of the tumour, resulting in higher rates of recurrence. [6][7][8] In micrographic surgery (MS), a method of margin control, excised tumours are sectioned horizontally, allowing the analysis of 100% of the lateral and deep surgical margins and avoiding sampling errors.…”

“…4,5 In conventional surgery (CS), a widely used method, tumours are excised for histological analysis using the 'bread loaf' method. 6,7 The tissue is sectioned vertically at random intervals of 2-4 mm to assess the presence of a tumour in the surgical margin. 6,7 However, these sections represent a sample of less than 1% of the surgical margins, and sampling errors can occur if the interval performed between the sections covers a subclinical extent of the tumour, resulting in higher rates of recurrence.…”

“…13,15 The Mohs technique is the most used worldwide, with limited use of other MS techniques. 7,16 No studies have been designed to compare the effectiveness of MS methods. Therefore, the main objective of this systematic review was to assess the total recurrence rate of BCC among the different MS techniques.…”

“…In micrographic surgery (MS), a method of margin control, excised tumours are sectioned horizontally, allowing the analysis of 100% of the lateral and deep surgical margins and avoiding sampling errors 7,9,10 . The correlation between the presence of tumour in the histological examination and the correct location on the surgical map ensures complete resection of malignant tumours with oncological safety 11 .…”