Mohs Micrographic Surgery: Development, Technique, and Applications in Cutaneous Malignancies

Chen, Eillen Luisa A.; Srivastava, Divya; Nijhawan, Rajiv I.

doi:10.1055/s-0038-1642057

Cited by 19 publications

(21 citation statements)

References 92 publications

(143 reference statements)

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“…1 Mohs micrographic surgery (MMS) is a surgical technique that allows evaluation of the entire peripheral and deep margins of excised skin malignancies, leading to higher cure rates, compared to conventional excision. 2 MMS also preserves the maximum normal adjacent tissue possible, resulting in smaller resection defects, and this can be especially important in aesthetic and functional areas, as in the face. 1,2 MMS represents an option for different types of skin malignancies, ranging from basal cell carcinoma, squamous cell carcinoma, atypical fibroxanthoma, dermatofibrosarcoma protuberans, Merkel cell carcinoma, microcystic adnexal carcinoma, sebaceous carcinoma, eccrine porocarcinoma, leiomyosarcoma, extramammary Paget's disease, aggressive digital papillary adenocarcinoma and even melanoma.…”

Section: Introductionmentioning

confidence: 99%

“…2 MMS also preserves the maximum normal adjacent tissue possible, resulting in smaller resection defects, and this can be especially important in aesthetic and functional areas, as in the face. 1,2 MMS represents an option for different types of skin malignancies, ranging from basal cell carcinoma, squamous cell carcinoma, atypical fibroxanthoma, dermatofibrosarcoma protuberans, Merkel cell carcinoma, microcystic adnexal carcinoma, sebaceous carcinoma, eccrine porocarcinoma, leiomyosarcoma, extramammary Paget's disease, aggressive digital papillary adenocarcinoma and even melanoma. 2 It can be used for the treatment of primary or recurrent/persistent tumors.…”

Section: Introductionmentioning

confidence: 99%

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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: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Silva

Catarino

Pimentel

et al. 2020

SPDV

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“…Therefore, it is necessary for the Mohs surgeon to be an educated dermatopathologist at the same time [9]. This method achieves the best results in the treatment of non-melanoma skin cancers, especially in regions where it is important to preserve function and/or cosmetic results, such as the maxillofacial region [10]. Cryosurgery in the treatment of skin cancer is limited to well-limited, low-risk superficial lesions that are smaller than 20 mm in diameter [11].…”

Section: Discussionmentioning

confidence: 99%

“…Zbog toga je neophodno da Mohs hirurg istovremeno bude edukovan dermatopatolog [9]. Ovom metodom se postižu najbolji rezultati u lečenju nemelanomskih karcinoma kože, a naročito u regijama gde je važno očuvati funkciju i/ili kozmetski rezultat, kao što je maksilofacijalna regija [10].…”

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Locally advanced basal cell carcinoma of the auricle and parotid region: A case report

et al. 2021

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Skin cancers are the most common malignant tumors in general. The most significant risk factor is exposure to UV radiation. They mainly occur in the head and neck region, and the majority of about 80% are basal cell carcinomas. Surgery is standard treatment of uncomplicated basal cell carcinomas, but a multidisciplinary approach is necessary in advanced cases. The case report refers to a patient with locally advanced recurrent basal cell carcinoma with primary tumor localization in the right auricle and parotid region in 2012 when primary surgery was performed. Due to the local recurrence, amputation of the right auricle and trepanation of the mastoid process was done in November 2018, and after that, radiation therapy of a recurrent tumor in the area of the trepanation cavity was applied. In the course of follow-up so far, there is good local control, without signs of toxicity. The case report points to the importance of a multidisciplinary approach and the role of radiotherapy in the treatment and control of advanced basal cell carcinoma of this region.

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“…Definitive treatment of AMHN includes surgical resection. For melanomas in situ , Mohs surgery is the most cost‐effective, tissue‐conserving option 18–20 ; however, for invasive melanomas, a wide local excision is recommended. The recommendation for the surgical excisional margins of AMHN follows the same principles suggested by the National Comprehensive Cancer Network clinical guidelines 21,22 .…”

Section: Discussionmentioning

confidence: 99%

Amelanotic melanoma of the head and neck: analysis of tumor characteristics from the National Cancer Database

et al. 2020

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Background Amelanotic melanoma is an extremely rare subtype of cutaneous melanoma. The tumor characteristics are still not well understood, especially for those located in the head and neck. Methods Tumor characteristics of patients diagnosed with amelanotic melanoma of the head and neck (AMHN) from January 1, 2004, to December 31, 2015, were analyzed by querying the National Cancer Database. Characteristics of AMHN were subsequently compared with common malignant melanoma of the head and neck (CMMHN). Results Three hundred and sixty‐eight patients were diagnosed with AMHN, and 69,267 were diagnosed with CMMHN. Of those with AMHN, 128 (34.8%) had melanoma located on the scalp and neck, and 172 (46.7%) were diagnosed with an early disease stage (i.e., 0, I, or II). When compared with CMMHN, patients with AMHN were more likely to be diagnosed after 80 years of age (25.3% vs. 18.2%; odds ratio [OR], 3.28; 95% CI, 1.09–9.84; P = 0.03), when Breslow depth was between 2.01 and 4.00 mm (28.5% vs. 6.5%; OR, 1.92; 95% CI, 1.15–3.19; P = 0.01), when ulceration was present (36.7% vs. 9.0%; OR, 1.99; 95% CI, 1.34–2.97; P = 0.001), and when mitotic count was 1 or more/mm2 (40.5% vs. 12.8%; OR; 2.53; 95% CI, 1.09–5.89; P = 0.03). No statistical difference was found for sex, specific location, stage, or lymph node involvement. Conclusion Our study determined that AMHN is associated with older age, increased Breslow depth, presence of ulceration, and greater mitotic count when compared with CMMHN.

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Mohs Micrographic Surgery: Development, Technique, and Applications in Cutaneous Malignancies

Cited by 19 publications

References 92 publications

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

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

Locally advanced basal cell carcinoma of the auricle and parotid region: A case report

Amelanotic melanoma of the head and neck: analysis of tumor characteristics from the National Cancer Database

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