Mohs surgery. Technique, indications, applications, and the future

Abstract

Each year, it is estimated, more than 500,000 new cases of nonmelanoma skin cancer develop. The majority of these cutaneous neoplasms are treated by various modalities that include excision, electrodesiccation and curettage, cryosurgery, and irradiation, with greater than 90% success. Certain of the remaining primary tumors, as well as recurrent carcinomas, present a demanding therapeutic challenge. For these lesions, Mohs surgery has evolved as the most reliable and cost-effective treatment modality, offering maximal preservation of normal tissue and therefore the lowest functional and cosmetic morbidity. In this review, the history and evolution of Mohs surgery and the technique itself will be briefly outlined. The indications for Mohs surgery, together with methods of handling the postoperative wound and future applications of the technique, will be discussed in detail.

High Recurrence Rates of Basal Cell Carcinoma After Mohs Surgery in Patients With Chronic Lymphocytic Leukemia

“…[3][4][5] Our BCC control group had a 2% recurrence rate, which is similar to prior reported estimates. [3][4][5] Numerous factors contribute to impaired host immune function in patients with CLL, 9 including hypogammaglobulinemia, low levels of complement, impaired granulocyte function, altered leukemic cell expression of class II major histocompatibility complex antigens, altered expression of T-cell receptor variable region genes, and functional defects in bystander and other T-cell subsets. B cells in patients with CLL also contribute to impaired host immune function by elaborating immunosuppressive factors.…”

“…[1][2][3] Use of micrographic surgery routinely results in the highest cure rates, concomitantly maximizing the preservation of normal adjacent tissue to simplify reconstruction of the defect. [3][4][5] Chronic lymphocytic leukemia is the most frequent form of leukemia in adults in Westerncountries. 6 Theestimatedincidence rate of CLL in the United States is 8100 new cases per year.…”

“…The patients who are best treated with the Mohs technique are those who have BCCs that are recurrent, incompletely excised, larger than 2 cm, poorly defined clinically, histologically aggressive, or located where they may have a propensity to grow along fascial or embryonic fusion planes. [3][4][5] Success rates with the use of Mohs technique for the treatment of primary BCCs are 97% to 99%. For recurrent BCCs, success rates are 96% to 98% with the Mohs technique compared with 50% to 65% with usual methods.…”

“…17 The size and histologic classification of the BCC correlate with prognosis. [3][4][5] Aggressive tumors tend to be larger or to exhibit infiltrative features, findings that, in turn, predict higher recurrence rates. 18,19 Because numerous case series anecdotally suggest aggressive histologic behavior of nonmelanoma skin cancer in patients with CLL, larger BCCs with morpheaform, micronodular, and metatypical subtypes would be suspected to predominate in such patients.…”

The Physical and Clinical Aspects of Radiation Therapy in Skin Cancer and Subcutaneous Tissue Neoplasm

“…Thirdly, a volume of irradiation and number of joints involved to the target volume might be smaller, in comparison to a post-operative situation, and in this way, functional capacity of the limb can be improved. Finally, the proponents of the pre-operative radiotherapy believe that this method of irradiation, by causing shrinking of the tumor mass, can facilitate the subsequent surgical treatment [6]. In contrast, the opponents of this approach, emphasize the difficulties in assessment of a margin of the lesion that was previously irradiated, and can contribute to the increased risk of surgical complications; they also address the issue of lack of sufficient histopathological data, which generally are being provided in a post-operative report, related to the excised tumor.…”