Mohs surgery

Mohs micrographic surgeryMohs surgeonmohsMohs Micrographic Controlled SurgeryMohs surgery defectsMohs technique
Mohs surgery, developed in 1938 by a general surgeon, Frederic E. Mohs, is microscopically controlled surgery used to treat common types of skin cancer.wikipedia
67 Related Articles

Frederic E. Mohs

Mohs surgery, developed in 1938 by a general surgeon, Frederic E. Mohs, is microscopically controlled surgery used to treat common types of skin cancer.
Frederic Edward Mohs (1 March 1910 – 2 July 2002) was an American physician and general surgeon who developed the Mohs micrographic surgery (MMS) technique in 1938 to remove skin cancer lesions while still a medical student at the University of Wisconsin–Madison.

Basal-cell carcinoma

basal cell carcinomabasal cell cancerrodent ulcer
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.
This can be by simple excision if the cancer is small; otherwise Mohs surgery is generally recommended.

Complete circumferential peripheral and deep margin assessment

CCPDMA
Mohs surgery is the gold standard method for obtaining complete margin control during removal of a skin cancer (CCPDMA – complete circumferential peripheral and deep margin assessment) using frozen section histology. CCPDMA or Mohs surgery allows for the removal of a skin cancer with very narrow surgical margin and a high cure rate.
There are two forms of CCPDMA surgery: Mohs surgery and surgical excision coupled with margin assessment.

Frozen section procedure

frozen sectioncryosectioncryosectioning
Mohs surgery is the gold standard method for obtaining complete margin control during removal of a skin cancer (CCPDMA – complete circumferential peripheral and deep margin assessment) using frozen section histology.
But margin controlled surgery (CCPDMA) can be performed using a variety of tissue cutting and mounting methods, including Mohs surgery.

Squamous cell skin cancer

Bowen's diseaseErythroplasia of Queyratsquamous cell carcinoma
Mohs procedure is also used for squamous cell carcinoma, but with a lower cure rate.
This can be by simple excision if the cancer is small otherwise Mohs surgery is generally recommended.

Microcystic adnexal carcinoma

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.
Main treatments are wide local excision or Mohs micrographic surgery, which ensures that most, if not all, cancer cells are removed surgically.

Skin cancer

non-melanoma skin cancerskinskin neoplasm
Mohs surgery, developed in 1938 by a general surgeon, Frederic E. Mohs, is microscopically controlled surgery used to treat common types of skin cancer.
For a small basal-cell cancer in a young person, the treatment with the best cure rate (Mohs surgery or CCPDMA) might be indicated.

Melanoma

malignant melanomametastatic melanomamelanomas
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%).
Many surgeons consider 0.5 cm the standard of care for standard excision of melanoma-in-situ, but 0.2 cm margin might be acceptable for margin controlled surgery (Mohs surgery, or the double-bladed technique with margin control).

Histology

histologicalhistologichistologist
Mohs surgery is the gold standard method for obtaining complete margin control during removal of a skin cancer (CCPDMA – complete circumferential peripheral and deep margin assessment) using frozen section histology.
Frozen sections are often prepared during surgical removal of tumors to allow rapid identification of tumor margins, as in Mohs surgery, or determination of tumor malignancy, when a tumor is discovered incidentally during surgery.

Keratoacanthoma

Keratoacanthoma centrifugum marginatumFerguson–Smith syndromeGeneralized eruptive keratoacanthoma
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.
(On the nose and face, Mohs surgery may allow for good margin control with minimal tissue removal, but many insurance companies require the definitive diagnosis of a malignancy before they are prepared to pay the extra costs of Mohs surgery.) Especially in more cosmetically-sensitive areas, and where the clinical diagnosis is reasonably certain, alternatives to surgery may include no treatment (awaiting spontaneous resolution).

Sebaceous carcinoma

sebaceous neoplasmssebaceous tumorsebaceous tumors
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.
Wide local excision, which has been replaced by Mohs micrographic surgery had been the primary treatment for both ocular and extraocular sebaceous carcinoma.

H&E stain

H&Ehematoxylin and eosinHaematoxylin and eosin stain
Alternatively, H&E stain is the most used stain in Mohs surgery in which tissues are typically frozen, cut on a cryostat (a microtome that cuts frozen tissue), fixed in alcohol, and then stained.

Dermatofibrosarcoma protuberans

DFSPDermatofibrosarcomaDermatofibrosarcoma protruberans
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.
The NCCN guideline recommends CCPDMA or Mohs surgery for the best cure rate of DFSP.

American College of Mohs Surgery

*American College of Mohs Surgery
The American College of Mohs Surgery (abbreviated as ACMS) is a membership-based organization of surgeons who are fellowship-trained in Mohs surgery, a technique that removes skin cancer in stages, one tissue layer at a time.

Black salve

Cansema
This paste is similar to black salve or "Hoxsey's paste" (see Hoxsey Therapy), a fraudulent patent medicine, but its usage is different.
The effectiveness of escharotics is unproven, while safer and more effective conventional treatments exist for skin cancers, such as: cryotherapy; topical agents such as imiquimod, fluorouracil and ingenol mebutate; radiation therapy; and surgical excision, including Mohs surgery (microscopically controlled surgery used to remove and test cancerous tissue).

Zinc chloride

ZnCl 2 chloride of zinczinc(II) chloride
It was made of zinc chloride and bloodroot (the root of the plant Sanguinaria canadensis, which contains the alkaloid sanguinarine).
Given these side-effects, its use in treatment is not warranted as there are much safer and more effective alternatives, such as radiation therapy and Mohs surgery.

General surgery

general surgeongeneralgeneral surgical
Mohs surgery, developed in 1938 by a general surgeon, Frederic E. Mohs, is microscopically controlled surgery used to treat common types of skin cancer.

Resection margin

surgical marginfree marginmargin
CCPDMA or Mohs surgery allows for the removal of a skin cancer with very narrow surgical margin and a high cure rate.

Merkel-cell carcinoma

Merkel cell carcinomaMerkel cell cancercarcinoma
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.

Paget's disease of the breast

Paget's diseasePaget's disease of the nippleMammary Paget’s disease
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.

Atypical fibroxanthoma

fibroxanthoma
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.

Leiomyosarcoma

cutaneous leiomyosarcomaLeimyosarcomaleiomyosarcomas
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.

Bread loafing

It is different from the standard bread loafing technique of sectioning, where random samples of the surgical margin are examined.

Cryostat

continuous flow cryostatcryogenic systemcryostats
After each surgical removal of tissue, the specimen is processed, cut on the cryostat and placed on slides, stained with H&E and then read by the Mohs surgeon/pathologist who examines the sections for cancerous cells.