Patient Indications for Mohs Micrographic Surgery: A Clinical Practice Guideline

Murray, Christian; Sivajohanathan, Duvaraga; Hanna, Timothy P.; Bradshaw, Scott H.; Solish, Nowell; Moran, Benvon; Hekkenberg, Robert; Wei, Alice C.; Petrella, Teresa M.

doi:10.3747/co.26.4439

Cited by 14 publications

(7 citation statements)

References 22 publications

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“…An increasingly used surgical technique for treatment of BCCs on the face is Mohs micrographic surgery (MMS). MMS is a technique where residual tumor is histologically mapped after each excision 5 . In case of a negative slide, no further surgery is needed, and the defect can be closed or left for secondary healing.…”

Section: Introductionmentioning

confidence: 99%

Whole‐slide margin control through deep learning in Mohs micrographic surgery for basal cell carcinoma

Zon

Waa

Veta

et al. 2021

Experimental Dermatology

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BackgroundBasal cell carcinoma (BCC) is the most common type of skin cancer with incidence rates rising each year. Mohs micrographic surgery (MMS) is most often chosen as treatment for BCC on the face for which each frozen section has to be histologically analysed to ensure complete tumor removal. This causes a heavy burden on health economics.ObjectivesTo develop and evaluate a deep learning model for the automated detection of BCC‐negative slides and classification of BCC in histopathology slides of MMS based on whole‐slide image (WSI).MethodsTwo deep learning models were developed on the basis of 171 digitized H&E frozen slides from 70 different patients. The first model had a U‐Net architecture and was used for the segmentation of BCC. A subsequent convolutional neural network used the segmentation to classify the whole slide as BCC or BCC‐negative.ResultsQuantitative evaluation over manually labelled ground truth data resulted in a Dice score of 0.66 for the segmentation of BCC and an area under the receiver operating characteristic curve (AUC) of 0.90 for the slide‐level classification.ConclusionsThis study demonstrates that through WSIs deep learning models may be a feasible option to improve the clinical workflow and reduce costs in histological analysis of BCC in MMS.

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Section: Introductionmentioning

confidence: 99%

Whole‐slide margin control through deep learning in Mohs micrographic surgery for basal cell carcinoma

Zon

Waa

Veta

et al. 2021

Experimental Dermatology

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“…Traditional MMS, with 1-year recurrence rates of 0.2% and favorable cosmetic results is considered a gold-standard efficacious and safe procedure for the treatment of BCCs and SCCs ( 2 , 3 , 9 ). However, MMS is costly, time-consuming, and in a not-for-profit health care delivery setting can only feasibly be employed for high-risk facial tumors ( 10 , 11 ). Our experience with MTMS strongly suggests that this technique provides a robust alternative for the simple excision of tumors that do not fulfill the criteria for MMS or where there is lack of access to MMS.…”

Section: Discussionmentioning

confidence: 99%

Muffin Technique Micrographic Surgery for Non-melanoma Skin Cancer

Surmanowicz

Sivanand

et al. 2021

Front. Med.

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Background: Mohs micrographic surgery (MMS) is the gold standard treatment for high-risk facial non-melanoma skin cancer. However, patients' access to MMS is limited by cost. The muffin technique micrographic surgery (MTMS) is an alternative micrographic technique wherein the entire excised margin is evaluated post-operatively by a pathologist using paraffin-embedded material. Herein, we describe the implementation and the preliminary results of MTMS in an academic dermatology center.Objective: To describe the MTMS and outline its efficacy and safety in a real-world clinical academic setting.Methods: A retrospective chart review was conducted of all patients with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) who underwent MTMS at the University of Alberta Dermatology Center from June 2016 until July 2019.Results: A total of 69 patients were included (64 BCCs and 5 SCCs). 68.1% of surgeries had clear margins following the first incision, 100% after second round re-excisions. There were no observed cases of tumor recurrence after a median 40 months of follow-up. There were no major adverse events or complications.Conclusions: MTMS is a superior alternative to simple excision of skin cancer by providing full margin control and residual tumor mapping.

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“…From referral to definitive treatment, in the U.K., it is mandated that a patient with a malignant skin lesion should have a maximum 62-day wait time [13]. Surgical wait times were also defined in Australia based on the classification of either malignant or non-malignant, whereby the maximum wait time for each type from the time of consent to surgery is 30 days and 365 days, respectively [14]. In Ontario, wait times for melanoma surgery in Ontario will be instituted in alignment with other Ontario wait time recommendations: 4 weeks from the time of consent to definitive surgery [28].…”

Section: Discussionmentioning

confidence: 99%

“…The appropriate services were then enumerated ( Table 2). In general, complex skin cancer diagnoses are to be referred to an RCC or an MMS center, whereas non-complex skin cancer diagnoses can be treated in the community outside of an RCC [14]. At least one complete survey was received from each LHIN, with a total of 44 responses that illustrate the access to skin cancer care services (Appendix B).…”

Section: Definitions Of Complex and Non-complex Skin Cancers And Clinmentioning

confidence: 99%

Restructuring Skin Cancer Care in Ontario: A Provincial Plan

et al. 2021

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There is a global rise in skin cancer incidence, resulting in an increase in patient care needs and healthcare costs. To optimize health care planning, costs, and patient care, Ontario Health developed a provincial skin cancer plan to streamline the quality of care. We conducted a systematic review and a grey literature search to evaluate the definitions and management of skin cancer within other jurisdictions, as well as a provincial survey of skin cancer care practices, to identify care gaps. The systematic review did not identify any published comprehensive skin cancer management plans. The grey literature search revealed skin cancer plans in isolated regions of the United Kingdom (U.K.), National Institute for Health and Care Excellence (NICE) guidelines for skin cancer quality indicators and regional skin cancer biopsy clinics, and wait time guidelines in Australia and the U.K. With the input of the Ontario Cancer Advisory Committee (CAC), unique definitions for complex and non-complex skin cancers and the appropriate cancer services were created. A provincial survey of skin cancer care yielded 44 responses and demonstrated gaps in biopsy access. A skin cancer pathway map was created and a recommendation was made for regional skin cancer biopsy clinics. We have created unique definitions for complex and non-complex skin cancer and a skin cancer pathways map, which will allow for the implementation of both process and performance metrics to address identified gaps in care.

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Patient Indications for Mohs Micrographic Surgery: A Clinical Practice Guideline

Cited by 14 publications

References 22 publications

Whole‐slide margin control through deep learning in Mohs micrographic surgery for basal cell carcinoma

Whole‐slide margin control through deep learning in Mohs micrographic surgery for basal cell carcinoma

Muffin Technique Micrographic Surgery for Non-melanoma Skin Cancer

Restructuring Skin Cancer Care in Ontario: A Provincial Plan

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