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Mohs micrographic surgery (MMS) has evolved since the 1930s to become the standard of care for the treatment of many types of cutaneous tumors, both primary and recurrent.
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MMS is a methodical technique that examines 100% of the tumor margin. Precise mapping and staged removal result in the highest cure rates for skin cancers, while sparing normal, uninvolved tissue.
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The surgical technique is a low-risk and cost-effective single-day procedure that is performed in the outpatient setting.
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The Mohs
Mohs Micrographic Surgery
Section snippets
Key points
Origins
MMS is named after its founder, Dr Frederic E. Mohs (1910–2002). In medical school, Dr Mohs first conceived of the idea of complete microscopic control of excisions while working with animal tumor models.1, 2, 3 Standard tissue processing for skin pathology uses vertical, or breadloaf, sections, which do not completely evaluate the peripheral or deep surgical margins in most cases.4 Dr Mohs proposed using a tissue fixative and then removing the tissue in horizontal layers so that the entire
Preoperative Evaluation
Preoperatively, the patient should undergo either a separate-day or same-day surgical consultation.18 The consultation includes a thorough medical record review and provides the patient with an explanation of the tumor etiology and prognosis, treatment options and risk factors, reconstructive possibilities, postoperative wound care instructions (including activity limitation, pain control, and medication management), and a general overview of the day of surgery.19 Written informed consent
Use of Mohs surgery
MMS is indicated for numerous cutaneous tumors, depending on their clinical appearance, size, location, histologic findings, prior treatment, and patient immune status and/or genetic syndromes.82 Most tumors treated with Mohs surgery are BCCs and SCCs. In 2012, the American Academy of Dermatology, in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery, established appropriate use criteria
Summary
MMS is a precise, methodical procedure to treat skin cancer that examines the complete surgical margin and conserves the maximum amount of healthy tissue. Contiguous cutaneous tumors can be accurately tracked with the technique, resulting in the highest cure rates. MMS is the treatment of choice for many tumors, such as BCC, SCC, MIS, and other less common tumors. The Mohs surgeon can be a valuable addition to a multidisciplinary approach to treating cutaneous tumors.
References (132)
Frederic E. Mohs, M.D
J Am Acad Dermatol
(1983)Comparison of methods for checking surgical margins
J Am Acad Dermatol
(1990)- et al.
Understanding Mohs micrographic surgery: a review and practical guide for the nondermatologist
Mayo Clin Proc
(2017) - et al.
Shared medical appointments for the preoperative consultation visit of Mohs micrographic surgery
J Am Acad Dermatol
(2015) - et al.
Antibiotic prophylaxis in dermatologic surgery: advisory statement 2008
J Am Acad Dermatol
(2008) - et al.
Smoking and alcohol intervention before surgery: evidence for best practice
Br J Anaesth
(2009) - et al.
Site identification challenges in dermatologic surgery: a physician survey
J Am Acad Dermatol
(2012) - et al.
The role of imaging in the management of patients with nonmelanoma skin cancer: when is imaging necessary?
J Am Acad Dermatol
(2017) - et al.
The use of oral midazolam for perioperative anxiolysis of healthy patients undergoing Mohs surgery: conclusions from randomized controlled and prospective studies
J Am Acad Dermatol
(2011) - et al.
Guidelines for the use of local anesthesia in office-based dermatologic surgery
J Am Acad Dermatol
(2016)
Safety of peak serum lidocaine concentration after Mohs micrographic surgery: a prospective cohort study
J Am Acad Dermatol
Randomized, controlled surgical trial of preoperative tumor curettage of basal cell carcinoma in Mohs micrographic surgery
J Am Acad Dermatol
Histologic pitfalls in the Mohs technique
Dermatol Clin
Mohs mapping fidelity: optimizing orientation, accuracy, and tissue identification in Mohs surgery
Dermatol Surg
Mohs micrographic surgery for the management of cutaneous malignancies
Facial Plast Surg Clin North Am
Mohs micrographic surgery technique
Dermatol Clin
Setting up the Mohs surgery laboratory
Dermatol Clin
Mohs micrographic surgery histopathology concordance
J Am Acad Dermatol
Needs assessment for Mohs micrographic surgery
Dermatol Clin
Special considerations for Mohs micrographic surgery on the eyelids, lips, genitalia, and nail unit
Dermatol Clin
Squamous cell carcinoma of the lip treated with Mohs micrographic surgery: outcome at 5 years
J Am Acad Dermatol
Mohs micrographic surgery for penile cancer: management and long-term followup
J Urol
Mohs micrographic surgery: a cost analysis
J Am Acad Dermatol
A relative value unit-based cost comparison of treatment modalities for nonmelanoma skin cancer: effect of the loss of the Mohs multiple surgery reduction exemption
J Am Acad Dermatol
Surgical excision versus Mohs' micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years' follow-up
Lancet Oncol
Basal cell carcinoma treated with Mohs surgery in Australia II. Outcome at 5-year follow-up
J Am Acad Dermatol
Chemosurgery in cancer, gangrene, and infections
Mohs micrographic surgery. A historical perspective
Dermatol Clin
Origin and progress of Mohs micrographic surgery
Chemosurgery in cutaneous malignancy
Calif Med
Chemosurgery: a microscopically controlled method of cancer excision
Arch Surg
Chemosurgical treatment of the face: a microscopically controlled method of excision
Arch Derm Syphilol
Fresh tissue chemosurgery for tumors of the nose
Eye Ear Nose Throat Mon
Chemosurgery: my 15 years of experience
J Dermatol Surg Oncol
Chemosurgery for skin cancer: fixed tissue and fresh tissue techniques
Arch Dermatol
Microscopically controlled excision of skin tumors
Arch Dermatol
Modern chemosurgery—microscopically controlled excision
West J Med
The history and evolution of Mohs micrographic surgery
Dermatol Surg
The meaning of surgical margins
Plast Reconstr Surg
Separate- versus same-day preoperative consultation in dermatologic surgery: a patient-centered investigation in an academic practice
Dermatol Surg
Complications of tissue ischemia in dermatologic surgery
Dermatol Ther
Antibacterial prophylaxis in dermatologic surgery: an evidence-based review
Am J Clin Dermatol
Cigarette smoking and flap and full-thickness graft necrosis
Arch Dermatol
Electrosurgery and implantable electronic devices: review and implications for office-based procedures
Dermatol Surg
The impact of herbal medicines on dermatologic surgery
Dermatol Surg
Dietary supplements: altered coagulation and effects on bruising
Dermatol Surg
Preoperative monitoring of warfarin in cutaneous surgery
Br J Dermatol
The management of antithrombotic medication in skin surgery
Dermatol Surg
Newer hemostatic agents used in the practice of dermatologic surgery
Dermatol Res Pract
Cited by (35)
Interest of frozen section procedure in skin tumors other than melanoma
2023, Journal of Plastic, Reconstructive and Aesthetic SurgeryBasal cell carcinoma
2023, FMC Formacion Medica Continuada en Atencion PrimariaMustardé flap for primary nasal sidewall defect post-Mohs micrographic surgery
2022, JAAD Case ReportsCitation Excerpt :Keratinocyte carcinoma occurs commonly on the face, owing to repeated exposure to ultraviolet radiation.1 Mohs micrographic surgery is the gold standard for treating these cutaneous tumors.2 This procedure provides margin clearance while preserving the surrounding tissue.
Factors associated with incomplete surgical margins in basal cell carcinoma of the head and neck
2021, Brazilian Journal of OtorhinolaryngologyCitation Excerpt :There are different means of reducing the risk of involvement of the surgical margins in cutaneous tumors. The most accepted is Mohs micrographic surgery, currently considered the gold standard for cutaneous oncologic surgery.24 This surgery is not routine at our tertiary center.
The Role of Mohs Surgery in Cutaneous Head and Neck Cancer
2021, Otolaryngologic Clinics of North AmericaCitation Excerpt :The paste itself was painful, and some patients reportedly required hospitalization for pain management. Residual surgical defects required delayed reconstruction, given the additional 7 to 10 days typically required for the fixed tissue site to slough off, leaving the healthy bed of granulation tissue.3 In 1953, Mohs wanted to speed the procedure time for a patient with pigmented basal cell carcinoma (BCC) of the lower eyelid.
Disclosures: No relevant financial disclosures for any authors.