Mohs surgery

Mohs surgery
The ear of a 63-year-old man, photographed sixteen days after Mohs surgery to remove a squamous cell carcinoma on the left upper edge of the ear, and three days after removal of the sutures.
MeSHD015580

Mohs surgery, developed in 1938 by a general surgeon, Frederic E. Mohs, is microscopically controlled surgery used to treat both common and rare types of skin cancer. During the surgery, after each removal of tissue and while the patient waits, the tissue is examined for cancer cells. That examination dictates the decision for additional tissue removal. Mohs surgery is the gold standard method for obtaining complete margin control during removal of a skin cancer (complete circumferential peripheral and deep margin assessment - CCPDMA) using frozen section histology.[1] CCPDMA or Mohs surgery allows for the removal of a skin cancer with very narrow surgical margin and a high cure rate.

The cure rate with Mohs surgery cited by most studies is between 97% and 99.8% for primary basal-cell carcinoma, the most common type of skin cancer.[2]: 13  Mohs procedure is also used for squamous cell carcinoma, but with a lower cure rate. Recurrent basal-cell cancer has a lower cure rate with Mohs surgery, more in the range of 94%.[2]: 7  It has been used in the removal of melanoma-in-situ (cure rate 77% to 98% depending on surgeon), and certain types of melanoma (cure rate 52%).[2]: 4 [3]: 211–20 

Other indications for Mohs surgery include dermatofibrosarcoma protuberans, keratoacanthoma, spindle cell tumors, sebaceous carcinomas, microcystic adnexal carcinoma, merkel cell carcinoma, Paget's disease of the breast, atypical fibroxanthoma, and leiomyosarcoma.[3]: 193–203 [4] Because the Mohs procedure is micrographically controlled, it provides precise removal of the cancerous tissue, while healthy tissue is spared. Mohs surgery can also be more cost effective than other surgical methods, when considering the cost of surgical removal and separate histopathological analysis. However, Mohs surgery should be reserved for the treatment of skin cancers in anatomic areas where tissue preservation is of utmost importance (face, neck, hands, lower legs, feet, genitals).[4]

  1. ^ Minton TJ (August 2008). "Contemporary Mohs surgery applications". Current Opinion in Otolaryngology & Head and Neck Surgery. 16 (4): 376–80. doi:10.1097/MOO.0b013e3283079cac. PMID 18626258. S2CID 10668953.
  2. ^ a b c Mikhail, George R.; Mohs, Frederic Edward (1991). Mohs micrographic surgery. Philadelphia: W.B. Saunders. p. 13. ISBN 978-0-7216-3415-9.
  3. ^ a b Gross, Kenneth Gary; Steinman, Howard K.; Rapini, Ronald P. (1999). Mohs Surgery: Fundamentals and Techniques. Saint Louis: Mosby. ISBN 978-0-323-00012-3.
  4. ^ a b Ad Hoc Task Force.; et al. (October 2012). "AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: a report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery". Journal of the American Academy of Dermatology. 67 (4): 531–50. doi:10.1016/j.jaad.2012.06.009. PMID 22959232.