Understanding Mohs Micrographic Surgery

Abstract

The incidence and diagnosis of cutaneous malignancies are steadily rising. In addition, with the aging population and increasing use of organ transplant and immunosuppressive medications, subsets of patients are now more susceptible to skin cancer. Mohs micrographic surgery (MMS) has become the standard of care for the treatment of high-risk nonmelanoma skin cancers and is increasingly used to treat melanoma. Mohs micrographic surgery has the highest cure rates, spares the maximal amount of normal tissue, and is cost-effective for the treatment of cutaneous malignancies. As in other medical fields, appropriate use criteria were developed for MMS and have become an evolving guideline for determining which patients and tumors are appropriate for referral to MMS. Patients with cutaneous malignancies often require multidisciplinary care. With the changing landscape of medicine and the rapidly increasing incidence of skin cancer, primary care providers and specialists who do not commonly manage cutaneous malignancies will need to have an understanding of MMS and its role in patient care. This review better familiarizes the medical community with the practice of MMS, its utilization and capabilities, differences from wide excision and vertical section pathology, and cost-effectiveness, and it guides practitioners in the process of appropriately evaluating and determining when patients with skin cancer might be appropriate candidates for MMS.

The Treatment of Non-Melanoma Skin Cancer with Image-Guided Superficial Radiation Therapy: An Analysis of 2917 Invasive and In Situ Keratinocytic Carcinoma Lesions

“…Recent studies of the effectiveness of MMS observed 5-year local control rates of 99% and 92–99% for primary BCC and SCC, respectively; the corresponding rates for recurrent BCC and SCC treated with MMS are 90–93% and 90%, respectively [ 3 ]. Comparison of the results of this study with those achievable using surgical therapies, such as MMS, may be limited.…”

Comparison of basal cell carcinoma subtypes observed in preoperative biopsy and Mohs micrographic surgery

“…Traditionally, the Mohs surgeon assesses histological slides during the procedure. 28 For this, these surgeons undergo intense training in dermatopathology of skin tumors. In the United States, for example, Mohs surgeons perform about 1.500 MMSs during fellowship, over one year.…”

Localized sebaceous carcinoma treatment: Wide local excision verses Mohs micrographic surgery

“…One population‐based study reported a 78% disease‐specific survival rate at 5 years 17 . Yet, a great concern to SC treatment is incomplete removal of the primary tumor 12,19 . MMS allows for microscopic control of the margin and translates to both superior cure rates and sparing of normal tissue 19 .…”

“…Yet, a great concern to SC treatment is incomplete removal of the primary tumor 12,19 . MMS allows for microscopic control of the margin and translates to both superior cure rates and sparing of normal tissue 19 . MMS has been show to lower recurrence rates 13,20 .…”

“…MMS has been show to lower recurrence rates 13,20 . Other benefits of MMS include shorter healing time and minimal scar formation due to the increased preservation of underlying soft tissue including the subcutaneous fat, muscles, nerves, and other important structures outside of the epidermis and dermis 19 . Based on previous studies showing MMS independently associated with greater patient satisfaction and small scar formation, 21,22 and coupled with this study's survival findings, MMS may become the preferred treatment recommendation for SC management.…”