Laboratory Errors Leading to Nonmelanoma Skin Cancer Recurrence After Mohs Micrographic Surgery

Zabielinski, Marilyn; Leithauser, Laurel; Godsey, Tonja; Gloster, Hugh Morris

doi:10.1097/dss.0000000000000428

Cited by 17 publications

(6 citation statements)

References 7 publications

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“…8,9 Reasons for explaining recurrence after MMS are failure to excise more tissue when a dense inflammatory infiltrate is present, presence of residual tumor at the margins, missing epidermis or dermis, multifocal tumor and wrong inking of the lesion. 10 In our case, recurrence results may also be due to a higher complexity of the tumors (larger, more infiltrative and more aggressive) as more than half of these patients with recurrent disease were complex cases, referred from other centers, mostly persistent/recurrent basal cell carcinomas that needed closure by skin flap or skin graft.…”

Section: Discussionmentioning

confidence: 68%

6 Years’ Experience of Mohs Micrographic Surgery in a Portuguese Hospital

Silva

Catarino

Pimentel

et al. 2020

SPDV

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Introduction: Mohs micrographic surgery (MMS) is a surgical method of treating skin tumors that consists of histological control of the tumor margins using horizontal slices in thin, freshly frozen layers. This technique is a preferred indication for cutaneous facial tumors (basal and squamous cell carcinoma, among others) associated with higher risk of recurrence, recurrent tumors, tumors with undefined clinical margins, when there is perivascular and perineural involvement or with aggressive histological subtypes. Methods: The authors carried out a retrospective study of a 6-year period (from July 2012 until June 2018) at a Portuguese hospital – Egas Moniz hospital, to define the characteristics of patients undergoing Mohs micrographic surgery and to evaluate the advantages of this technique. The following factors were analyzed: age, gender, provenience, diagnosis, tumor location, number of stages of MMS, type of reconstruction of the surgical defect, follow-up and recurrences. Results: A total of 835 tumors were excised, 459 in male patients and 376 in female patients. The mean age at surgery was 71 years old (range 23- 95 years). Most of the lesions submitted to MMS were basal cell carcinomas (87%) and the most common location was the nasal pyramid (43%). In 44% of the cases, it was necessary to perform more than one micrographic stage. Half of the surgical defect closures were performed by graft or skin flap. Considering patients with a follow up equal or superior to 3 years, the recurrence rate was 4.9%. Discussion: The most frequent diagnosis was basal cell carcinoma, reflecting the importance of MMS in this type of skin malignancy, in both primary and persistent/recurrent lesions. Compared to other European surgery reviews, our recurrence rate is within normal range. This fact is particularly relevant, if we consider that our institution receives patients sent from hospitals and dermatologists from all over the country, specially selected for tumor aggressiveness or previous relapse. More than half of these patients were referred from other centers and consisted of persistent/recurrent basal cell carcinomas. The follow-up at recurrence for MMS was 27.9 months, supporting that a long follow-up of these patients is necessary. Conclusion: MMS allows lower rates of recurrence compared to simple surgical excision, so its practice should be encouraged in selected tumors. The surgical control of the margins instead of the “blind margins” is an advantage in saving healthy tissue and allows the complete excision of the tumor in the same surgical time.

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Section: Discussionmentioning

confidence: 68%

6 Years’ Experience of Mohs Micrographic Surgery in a Portuguese Hospital

Silva

Catarino

Pimentel

et al. 2020

SPDV

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“…Although cure rates with MMS approach 99%, local recurrences do occur . These recurrences may be explained by various factors, including noncontiguous tumors, surgical and histopathological error, incomplete representation of the margins in the Mohs frozen section slides, dense inflammatory infiltrates or fibrosis masking tumor, the occurrence of a new primary tumor in adjacent skin, etc . In our study, four cases of recurrence were found after MMS.…”

Section: Discussionmentioning

confidence: 55%

Basal cell carcinoma treated with Mohs micrographic surgery in young Ibero‐American patients

Aluma-Tenorio¹,

Ávila-Álvarez

Jaimes

et al. 2018

Int J Dermatology

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“…In addition, it’s important to take tissue fully around the mapped tumor positive area to limit the chance of sampling error of the second and subsequent stages. 36 , 37 Once margins are tumor-free, the Mohs surgeon or multi-specialty colleagues can safely reconstruct the wound.…”

Section: Preoperative Considerationsmentioning

confidence: 99%

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

Bittner

Cerci

Kubo³

et al. 2021

Anais Brasileiros de Dermatologia

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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.

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Laboratory Errors Leading to Nonmelanoma Skin Cancer Recurrence After Mohs Micrographic Surgery

Abstract: Local recurrences after MMS are extremely rare. When recurrences do occur, they can be attributed to errors in histological interpretation or tumor mapping.

Cited by 17 publications

References 7 publications

6 Years’ Experience of Mohs Micrographic Surgery in a Portuguese Hospital

6 Years’ Experience of Mohs Micrographic Surgery in a Portuguese Hospital

Basal cell carcinoma treated with Mohs micrographic surgery in young Ibero‐American patients

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

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