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Background From practice, we identified heterogeneity in Mohs micrographic surgery (MMS) specimen tissue processing techniques and specifications, and in the Mohs surgeons' assessment of MMS specimen histological tumour clearance. Aim By surveying an international cohort of Mohs surgeons, we determined to characterize variation in margin threshold assessment (number of wafers/sections free of tumour to declare tumour clearance). Methods An online questionnaire was distributed to Mohs surgeons in the UK, European countries, Australia and New Zealand, assessing the background demographics of the surgeons and the technical factors involved in MMS tissue processing and posing three MMS scenarios to define margin thresholds. Results In total, 114 consultant/attending‐level Mohs surgeons responded, giving a response rate of 33.5% from 20 countries (including UK nations). The first scenario posed was a 20‐mm cheek basal cell carcinoma (BCC) excised by MMS with a fully complete first wafer (7 μm) clear of tumour and the second wafer (after trimming interval of 50 μm) demonstrating a small dermal focus of nodular BCC; of the 58 surgeons, 16 (27.6%) would not take another stage. With a follow‐up question, 16 of the 58 (27.6%) surgeons specified wanting three clear sections to declare tumour clearance. When the same scenario had a change to a 20‐mm infiltrative BCC, 84.2% (48 of 57 surgeons) required a second MMS stage, with a follow‐up question clarifying that a third (19 of 57) wanted three clear sections to determine clearance. For a well‐differentiated 15‐mm squamous cell carcinoma with the same factors there was no majority consensus, with the same proportion of surgeons (22.6%; 12 of 53) calling tumour clearance after one, two and three clear section(s) respectively. For MMS specimen processing specifications, routine sections/wafers of 5–10 μm were reported by 77.4% of respondents (48 of 62) and for trimming interval values, 78.6% (48 of 61) specified a range between 20 and 200 μm. Conclusion By surveying international Mohs surgeons, we highlight surgeon background characteristics, peer‐compare assessment of margin thresholds for tumour clearance across three scenarios, and delineate tissue processing and intraoperative approaches.

Background:The use of surgical loupes has not been well-documented in dermatological surgery.Objectives: An online questionnaire was developed to characterize the use of loupes in dermatological surgery. Methods:The questionnaire was circulated to the memberships of the British Society of Dermatological Surgery, the European Society of Micrographic Surgery, and the Australasian College of Dermatologists. Responses were analyzed with a mixed methods approach using quantitative data analysis and inductive content analysis.Results: One-hundred twenty-five valid responses were received from 20 nations.Most respondents were from England (40%; 50/125), Australia (16%; 20/125), and the Netherlands (14.4%; 18/125). Overall, 71.2% (89/125) of respondents were consultants/Facharzt/attending. Furthermore, 55.2% (69/125) of respondents were Mohs surgeons. In dermatological surgery 38.4% (48/125) of respondents used surgical loupes routinely. The mode magnification level for loupes was 2.5× (67.5%; 27/40), with 3× second place (12.5%; 5/40). Exactly half (20/40) used through-the-lens style loupes and 40% (16/40) used flip-up-loupes. Inductive content analysis of the 51 freetext responses from nonloupe users uncovered several deterring factor themes, including expense (18/51), can manage without/don't need (14/51), and narrow field of view a(11/51), and uncomfortable/too heavy (9/51).Conclusions: This is the first time the use of surgical loupes in dermatological surgery has been internationally characterized.

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Cryosurgery using liquid nitrogen has been a preserve of UK dermatology since the 1970s. 1 Several cryosurgery methods exist but, in the UK at least, the open method prevails. In this approach, the nozzle of the cryosurgery device is placed perpendicular to the skin approximately 10 mm from the skin surface and liquid nitrogen is discharged, which immediately boils (boiling point À195.6 °C) and vaporizes in the air (Supplementary Video 1). 2 The liquid nitrogen aerosol lowers the skin temperature rapidly and a freeze-ball (ice-ball) is produced. This freeze-ball differentially damages tissue structures and cells; malignant cells require cooling to at least À50 °C for destruction, whereas melanocytes are more temperature-sensitive (dying at temperatures < À50 °C) and their destruction is the likely cause of potential dyspigmentation post cryosurgery. 1,3 Isolated superficial basal cell carcinomas (sBCCs) in noncritical sites such as the main body area are reasonable candidates for cryosurgery and supported by the 2021 British Association of Dermatologists guideline on