Download PDF
Semin Plast Surg 2008; 22(4): 247-256
DOI: 10.1055/s-0028-1095884
© Thieme Medical Publishers

Management of Cutaneous Tumors with Mohs Micrographic Surgery

Krisinda C. Dim-Jamora1 , Jennifer B. Perone1
  • 1Department of Dermatology, Division of Dermatologic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
Further Information

Publication History

Publication Date:
07 November 2008 (online)

Also available at
    Permissions and Reprints

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

REFERENCES

  • 1 Mohs F E. Mohs micrographic surgery: a historical perspective.  Dermatol Clin. 1989;  7 609-611
    PubMedSearch in Google Scholar
  • 2 Brodland D G, Amonette R, Hanke C W, Robins P. The history and evolution of Mohs micrographic surgery.  Dermatol Surg. 2000;  26 303-307
    CrossrefPubMedSearch in Google Scholar
  • 3 Mohs F E. Chemosurgery: a microscopically controlled method of cancer excision.  Arch Surg. 1941;  42 279
    CrossrefPubMedSearch in Google Scholar
  • 4 Mohs F E. History of Mohs micrographic surgery. In: Roenigk RK, Roenigk HH Dermatologic Surgery: Principles and Practice. New York, NY; Marcel Dekker 1989: 783-789
    Search in Google Scholar
  • 5 Tromovitch T A, Stegman S J. Microscopically controlled excision of skin tumors: chemosurgery (Mohs): fresh tissue technique.  Arch Dermatol. 1974;  110 231-232
    CrossrefPubMedSearch in Google Scholar
  • 6 McGillis S T, Wheeland R G, Sebben J E. Current issues in the performance of Mohs micrographic surgery.  J Dermatol Surg Oncol. 1991;  17 681-684
    PubMedSearch in Google Scholar
  • 7 Shriner D L, McCoy D K, Goldberg D J, Wagner Jr R F. Mohs micrographic surgery: clinical review.  J Am Acad Dermatol. 1998;  39 79-97
    CrossrefPubMedSearch in Google Scholar
  • 8 Pennington B, Brent M R. Nonmelanoma of the skin and Mohs surgery.  Plast Reconstr Surg. 2004;  113 2233-2234
    PubMedSearch in Google Scholar
  • 9 Rigel DS Cancer of the Skin. Philadelphia, PA; Elsevier 2005: 167-173
    Search in Google Scholar
  • 10 Motley R, Kersey P, Lawrence C. Multiprofessional guidelines for the management of the patient with primary cutaneous squamous cell carcinoma.  Br J Dermatol. 2002;  146 18-25
    CrossrefPubMedSearch in Google Scholar
  • 11 Morman M R. Mohs micrographic surgery.  N J Med. 1989;  86 369-373
    PubMedSearch in Google Scholar
  • 12 Dzubow L M. Mohs surgery.  Lancet. 1994;  343 433-434
    CrossrefPubMedSearch in Google Scholar
  • 13 Robinson J K. Mohs micrographic surgery.  Clin Plast Surg. 1993;  20 149-156
    PubMedSearch in Google Scholar
  • 14 Clark D. Cutaneous micrographic surgery.  Otolaryngol Clin North Am. 1993;  26 185-202
    PubMedSearch in Google Scholar
  • 15 Chung V Q, Bernardo L, Jiang S B. Presurgical curettage reduces the number of Mohs stages by better delineating the subclinical extensions of tumor margins.  Dermatol Surg. 2005;  31 1094-1099
    PubMedSearch in Google Scholar
  • 16 Jih M H, Friedman P M, Goldberg L H, Kimyai-Asadi A. Currettage prior to Mohs micrographic surgery for previously biopsied nonmelanoma skin cancers: what are we curetting? Retrospective, prospective, and comparative study.  Dermatol Surg. 2005;  31 10-15
    PubMedSearch in Google Scholar
  • 17 Davis D A, Pellowski D M, Hanke C W. Preparation of frozen sections.  Dermatol Surg. 2004;  30 1479-1485
    CrossrefPubMedSearch in Google Scholar
  • 18 Murphy M, Brodland D, Zitelli J. The frequency of errors in reading Mohs pathology sections over a one-year fellowship. Paper presented at: Annual Meeting of the Mohs College May 3, 2007 Naples, FL;
    Search in Google Scholar
  • 19 Stein J M, Hrabovsky S, Schuller D E, Siegle R J. Mohs micrographic surgery and the otolaryngologist.  Am J Otolaryngol. 2004;  25 385-393
    PubMedSearch in Google Scholar
  • 20 Lang Jr P G. The role of Mohs micrographic surgery in the management of skin cancer and a perspective on the management of the surgical defect.  Clin Plast Surg. 2004;  31 5-31
    CrossrefPubMedSearch in Google Scholar
  • 21 Touma D J. Mohs' (sic) surgery to reduce the size of facial defects and necessity for complex repairs.  Plast Reconstr Surg. 2002;  110 1601
    PubMedSearch in Google Scholar
  • 22 Downes R N, Walker N P, Collin J R. Micrographic (Moh's) surgery in the management of periocular basal cell epitheliomas.  Eye. 1990;  4 160-168
    PubMedSearch in Google Scholar
  • 23 Lane J E, Kent D E. Surgical margins in the treatment of nonmelanoma skin cancer and Mohs micrographic surgery.  Curr Surg. 2005;  62 518-526
    CrossrefPubMedSearch in Google Scholar
  • 24 Rowe D E, Carroll R J, Day C L. Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up.  J Dermatol Surg Oncol. 1989;  15 315-328
    CrossrefPubMedSearch in Google Scholar
  • 25 Smeets N W, Krenkels G A, Essers B A et al.. Surgical excision vs. Mohs micrographic surgery for basal cell carcinoma of the face: randomized controlled trial.  Lancet. 2004;  364 1766-1772
    CrossrefPubMedSearch in Google Scholar
  • 26 Goldman G D. Squamous cell cancer: a practical approach.  Semin Cutan Med Surg. 1998;  17 80-95
    CrossrefPubMedSearch in Google Scholar
  • 27 Rudolph R, Zelac D E. Squamous cell carcinoma of the skin.  Plast Reconstr Surg. 2004;  114 82e-94e
    PubMedSearch in Google Scholar
  • 28 Marks R. Squamous cell carcinoma.  Lancet. 1996;  347 735-738
    CrossrefPubMedSearch in Google Scholar
  • 29 McCombe D, MacGill K, Ainslie J, Beresford J, Matthews J. Squamous cell carcinoma of the lower lip: a retrospective review of the Peter MacCallum Cancer Institute experience 1979–1988.  Aust N Z J Surg. 2000;  70 358-361
    CrossrefPubMedSearch in Google Scholar
  • 30 Mahoney E J, Dolan R W, Choi E E, Olbricht S M. Surgical reconstruction of lentigo maligna defects.  Arch Facial Plast Surg. 2005;  7 342-346
    CrossrefPubMedSearch in Google Scholar
  • 31 Cohen L M, McCall M W, Hodge S J et al.. Successful treatment of lentigo maligna and lentigo maligna melanoma with Mohs micrographic surgery aided by rush permanent sections.  Cancer. 1994;  73 2964-2970
    CrossrefPubMedSearch in Google Scholar
  • 32 Dawn M E, Dawn A G, Miller S J. Mohs surgery for the treatment of melanoma in situ: a review.  Dermatol Surg. 2007;  33 395-402
    CrossrefPubMedSearch in Google Scholar
  • 33 Anderson K W, Baker S R, Lowe L et al.. Treatment of head and neck melanoma, lentigo maligna subtype.  Arch Facial Plast Surg. 2001;  3 202-206
    CrossrefPubMedSearch in Google Scholar
  • 34 Zitelli J A, Mohs F E, Larson P, Snow S. Mohs micrographic surgery for melanoma.  Dermatol Clin. 1989;  7 833-843
    PubMedSearch in Google Scholar
  • 35 Nagi C, O'Grady T C, Izadpanah A. Mohs micrographically controlled surgery and the treatment of malignant melanoma.  Semin Oncol. 2002;  29 336-340
    CrossrefPubMedSearch in Google Scholar
  • 36 Harris T J, Hinckley D M. Melanoma of the head and neck in Queensland.  Head Neck Surg. 1983;  5 197-203
    CrossrefPubMedSearch in Google Scholar
  • 37 Zitelli J, Brown C D, Hanusa B H. Surgical margins for excision of primary cutaneous melanoma.  J Am Acad Dermatol. 2001;  45 579-586
    CrossrefPubMedSearch in Google Scholar
  • 38 Chan F M, O'Donell B A, Whitehead K et al.. Treatment and outcomes of malignant melanoma of the eyelid. A review of 29 cases in Australia.  Ophthalmology. 2007;  114 187-192
    CrossrefPubMedSearch in Google Scholar
  • 39 Zalla M J, Lim K K, DiCaudo D J, Gagnot M M. Mohs micrographic excision of melanoma using immunostains.  Dermatol Surg. 2000;  26 771-784
    CrossrefPubMedSearch in Google Scholar
  • 40 Albertini J G, Elston D M, Libow F F, Smith S B, Farley M F. Mohs micrographic surgery for melanoma: a case series, a comparative study of immunostains, an informative case report, and a unique mapping technique.  Dermatol Surg. 2002;  28 656-665
    CrossrefPubMedSearch in Google Scholar
  • 41 Davis D A, Kurtz K A, Robinson R A. Ultrarapid staining for cutaneous melanoma: study and protocol.  Dermatol Surg. 2005;  31(7 Pt 1) 753-756
    PubMedSearch in Google Scholar
  • 42 Simman R, DeFranzo A, Sanger C, Thompson J. Dermatofibrosarcoma protuberans of the face: surgical management.  J Craniofac Surg. 2005;  16 439-444
    CrossrefPubMedSearch in Google Scholar
  • 43 Loss L, Zeitouni N C. Management of scalp dermatofibrosarcoma protuberans.  Dermatol Surg. 2005;  31 1428-1433
    PubMedSearch in Google Scholar
  • 44 Parker T L, Zitelli J A. Surgical margins for excision of dermatofibrosarcoma protuberans.  J Am Acad Dermatol. 1995;  32 233-236
    CrossrefPubMedSearch in Google Scholar
  • 45 Gloster M W, Harris K R, Roenigk R K. A comparison between Mohs micrographic surgery and wide surgical excision for the treatment of dermatofibrosarcoma protuberans.  J Am Acad Dermatol. 1996;  35 82-87
    CrossrefPubMedSearch in Google Scholar
  • 46 Gollard R, Weber R, Kostky M P et al.. Merkel cell carcinoma: review of 22 cases with surgical, pathologic, and therapeutic considerations.  Cancer. 2000;  88 1842-1851
    CrossrefPubMedSearch in Google Scholar
  • 47 O'Connor W J, Roenigk R K, Brodland D G. Merkel cell carcinoma—comparison of Mohs micrographic surgery and wide excision in eighty-six patients.  Dermatol Surg. 1997;  23 929-933
    CrossrefPubMedSearch in Google Scholar
  • 48 Snow S, Madjar D D, Hardy S et al.. Microcystic adnexal carcinoma; report of 13 cases and review of the literature.  Dermatol Surg. 2001;  27 401-408
    CrossrefPubMedSearch in Google Scholar
  • 49 Sebastien T S, Nelson B R, Lowe L et al.. Microcystic adnexal carcinoma.  J Am Acad Dermatol. 1993;  29 840-845
    CrossrefPubMedSearch in Google Scholar
  • 50 Clement C I, Genge J, O'Donnell B A, Lochhead A G. Orbital and periorbital microcystic adnexal carcinoma.  Ophthal Plast Reconstr Surg. 2005;  21 97-102
    CrossrefPubMedSearch in Google Scholar
  • 51 Davis J L, Randle H W, Zalla M J, Roenigk R K, Brodland D G. A comparison of Mohs micrographic surgery and wide excision for the treatment of atypical fibroxanthoma.  Dermatol Surg. 1997;  23 105-110
    CrossrefPubMedSearch in Google Scholar
  • 52 Nelson B R, Hamlet K R, Gillard M et al.. Sebaceous carcinoma.  J Am Acad Dermatol. 1995;  33 1-15
    CrossrefPubMedSearch in Google Scholar
  • 53 Ratz J L, Luu-Duong S, Kulwin D R. Sebaceous carcinoma of the eyelid treated with Mohs surgery.  J Am Acad Dermatol. 1986;  14 668-673
    CrossrefPubMedSearch in Google Scholar
  • 54 Spencer J M, Nossa R, Tse D T, Sequeira M. Sebaceous carcinoma of the eyelid treated with Mohs micrographic surgery.  J Am Acad Dermatol. 2001;  44 1004-1009
    CrossrefPubMedSearch in Google Scholar
  • 55 Snow S N, Larson P O, Lucarelli M J et al.. Sebaceous carcinoma of the eyelid treated by Mohs surgery: report of nine cases with review of literature.  Dermatol Surg. 2002;  28 623-631
    CrossrefPubMedSearch in Google Scholar
  • 56 Cook J, Zitelli J A. Mohs micrographic surgery: a cost analysis.  J Am Acad Dermatol. 1998;  39 698-703
    CrossrefPubMedSearch in Google Scholar
  • 57 Bialy T L, Whalen J, Veledar E et al.. Mohs micrographic surgery vs. traditional surgical excision: a cost comparison analysis.  Arch Dermatol. 2004;  140 736-742
    CrossrefPubMedSearch in Google Scholar
  • 58 Essers B A, Dirksen C D, Nieman F H et al.. Cost-effectiveness of Mohs micrographic surgery vs. surgical excision for basal cell carcinoma of the face.  Arch Dermatol. 2006;  142 187-194
    CrossrefPubMedSearch in Google Scholar
  • 59 Gladstone H B, Stewart D. Algorithm for the reconstruction of complex facial defects.  Skin Therapy Lett. 2007;  12 6-9
    PubMedSearch in Google Scholar
  • 60 Dobke M K, Miller S H. Tissue repair after Mohs surgery: a plastic surgeon's view.  Dermatol Surg. 1997;  23 1061-1066
    CrossrefPubMedSearch in Google Scholar

Jennifer B PeroneM.D. 

Assistant Professor, Department of Dermatology, Division of Dermatologic Surgery, University of Texas Southwestern Medical Center at Dallas

5253 Harry Hines Blvd., Dallas, TX 75390-9162

Email: jennifer.perone@utsouthwestern.edu