Management of cutaneous tumors with mohs micrographic surgery

Abstract

Since the inception of Mohs micrographic surgery in the 1930s, this technique has proved its utility in the treatment of cutaneous tumors. This review describes the technique of Mohs micrographic surgery and the various indications for which it is used. We discuss the use of Mohs micrographic surgery for the following cutaneous tumors: basal cell carcinoma, squamous cell carcinoma, melanoma in situ, dermatofibrosarcoma protuberans, Merkel cell carcinoma, microcystic adnexal carcinoma, atypical fibroxanthoma, and sebaceous carcinoma. Mohs micrographic surgery is cost effective in the U.S. health care system because billing for the surgeon-pathologist and laboratory processing is bundled together. However, Mohs micrographic surgery may be more expensive in European systems because the Mohs technique surgeon, pathologist, and laboratory fees may be billed separately.

Keywords: Mohs micrographic surgery; cutaneous oncology; skin cancer.

Figure 1

Debulking of the gross tumor using the scalpel technique.

Figure 2

Taking a stage for Mohs micrographic surgery. Care is taken to bevel the edges, keep epidermis intact around the entire specimen, and to avoid any defects at the depth of the specimen.

Figure 3

Once the specimen is completely removed from the patient, the hash marks are inked with colored ink to allow for precise orientation.

Figure 4

An example of a map drawn for stage 1. Note symbols used to indicate ink colors at each of the four hash marks (at 12, 3, 6, and 9 o'clock positions).

Figure 5

An example of a histologic slide prepared from stage 1 of Mohs micrographic surgery. Note the intact epidermis surrounding the entire specimen and the complete nature of the central portion of each section. This ensures the complete surgical margin is evaluated.