Mohs Surgery

  • Desiree Ratner
  • Jennifer L. MacGregor


Mohs surgery is named after Dr. Frederic Mohs, who pioneered a technique for removing cancers termed “chemosurgery” and first published his technique in 1941.1 Dr. Mohs’ initial method involved applying a zinc chloride paste directly to the patient’s tumor to chemically fix the tissue, after which the patient was allowed to return home. On the following day, the patient came back to the office. The tumor was then removed in precise, serial layers that were horizontally oriented and systematically mapped. This allowed all peripheral and deep margins of the specimen—essentially the interface between the patient and his or her tumor—to be examined under the microscope. If any part of the tumor remained, these steps were repeated until all peripheral and deep margins were clear. The goal of “chemosurgery” was to remove the tumor in its entirety, while preserving the surrounding normal skin. In this original technique, necrotic wounds created by zinc chloride paste were allowed to heal by second intention, as they were unsuitable for surgical reconstruction.


Merkel Cell Carcinoma Zinc Chloride Permanent Section Dermatofibrosarcoma Protuberans Sebaceous Carcinoma 
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  1. 1.
    Mohs FE. Chemosurgery: a microscopically controlled method of cancer excision. Arch Surg. 1941;42:279–295.Google Scholar
  2. 2.
    Drake LA, Dinehart SM, Goltz RW, et al. Guidelines of care for Mohs micrographic surgery. J Am Acad Dermatol. 1995;33:271–278.CrossRefPubMedGoogle Scholar
  3. 3.
    Rowe DE, Carroll RJ, Day CL. Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma. J Dermatol Surg Oncol. 1989;15(4):424–431.PubMedGoogle Scholar
  4. 4.
    Leibovitch I, Huilgol SC, Selva D, et al. Basal cell carcinoma treated with Mohs surgery in Australia II. Outcome at 5-year follow-up. J Am Acad Dermatol. 2005;53(3):452–457.CrossRefPubMedGoogle Scholar
  5. 5.
    Smeets NWJ, Kuijpers DIM, Nelemans P, et al. Mohs’ micrographic surgery for treatment of basal cell carcinoma of the face—results of a retrospective study and review of the literature. Br J Dermatol. 2004;151:141–147.CrossRefPubMedGoogle Scholar
  6. 6.
    Rowe DE, Carroll RJ, Day CL. Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. J Am Acad Dermatol. 1992;26:976–990.CrossRefPubMedGoogle Scholar
  7. 7.
    Leibovitch I, Huilgol SC, Selva D, et al. Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia I. Experience over 10 years. J Am Acad Dermatol. 2005;53(2):253–260.CrossRefPubMedGoogle Scholar
  8. 8.
    Mohs FE. Chemosurgery: microscopically controlled surgery for skin cancer—past, present and future. J Dermatol Surg Oncol. 1978;4:41–54.PubMedGoogle Scholar
  9. 9.
    Mohs FE. Chemosurgery for the microscopically controlled excision of cutaneous cancer. Head Neck Surg. 1978;1:150–163.CrossRefPubMedGoogle Scholar
  10. 10.
    Robins P, Dzubow LM, Rigel DS. Squamous-cell carcinoma treated by Mohs surgery: an experience with 414 cases in a period of 15 years. J Dermatol Surg Oncol. 1981;7:800–801.PubMedGoogle Scholar
  11. 11.
    Dzubow LM, Rigel DS, Robins P. Risk factors for local recurrence of primary cutaneous squamous cell carcinoma: treatment by microscopically controlled excision. Arch Dermatol. 1982;118:900–902.CrossRefPubMedGoogle Scholar
  12. 12.
    Holmkvist KA, Roenigk RK. Squamous cell carcinoma of the lip treated with Mohs micrographic surgery: outcome at 5 years. J Am Acad Dermatol. 1998;38:960–966.CrossRefPubMedGoogle Scholar
  13. 13.
    Mehrany K, Weenig RH, Pittelkow MR, et al. High recurrence rates of squamous cell carcinoma after Mohs surgery in patients with chronic lymphocytic leukemia. Dermatol Surg. 2005;31(1):38–42.CrossRefPubMedGoogle Scholar
  14. 14.
    Kirkorian AY, Moore BL, Siskind J, et al. Perioperative management of anticoagulant therapy during cutaneous surgery: 2005 survey of Mohs surgeons. Dermatol Surg. 2007;33(10):1189–1197.CrossRefPubMedGoogle Scholar
  15. 15.
    Alcalay J, Alkalay R. Controversies in perioperative management of blood thinners in dermatologic surgery: continue or discontinue? Dermatol Surg. 2004;30(8):1091–1094.CrossRefPubMedGoogle Scholar
  16. 16.
    Dixon AJ, Dixon MP, Dixon JB. Bleeding complications in skin cancer surgery are associated with warfarin but not aspirin therapy. Br J Surg. 2007;94:1356–1360.CrossRefPubMedGoogle Scholar
  17. 17.
    Wilson W, Taubert KA, Gewitz M, et al. Prevention of Infective Endocarditis Guidelines From the American Heart Association. Circulation. 2007;116:1736–1754.CrossRefPubMedGoogle Scholar
  18. 18.
    American Academy of Orthopaedic Surgeons Advisory Statement on Antibiotic Prophylaxis for Dental Patients with Total Joint Replacements. Accessed 1/21/09.
  19. 19.
    Wright TI, Baddour LM, Berbari EF, et al. Antibiotic prophylaxis in dermatologic surgery: Advisory statement. J Am Acad Dermatol. 2008;59:464–473.CrossRefPubMedGoogle Scholar
  20. 20.
    Ratner D, Bagiella E. The efficacy of curettage in delineating margins of basal cell carcinoma before mohs micrographic surgery. Dermatol Surg. 2003;29(9):899–903.CrossRefPubMedGoogle Scholar
  21. 21.
    Lee DA, Ratner D. Economic impact of preoperative curettage before mohs micrographic surgery for basal cell carcinoma. Dermatol Surg. 2006;32(7):916–923.CrossRefPubMedGoogle Scholar
  22. 22.
    Huang CC, Boyce S, Northington M, et al. Randomized, controlled surgical trial of preoperative tumor curettage of basal cell carcinoma in Mohs micrographic surgery. J Am Acad Dermatol. 2004;51(4):585–591.CrossRefPubMedGoogle Scholar
  23. 23.
    Chung VQ, Bernardo L, Jiang SB. Presurgical curettage appropriately reduces the number of Mohs stages by better delineating the subclinical extensions of tumor margins. Dermatol Surg. 2005;31(9 Pt 1):1094–1100.PubMedGoogle Scholar
  24. 24.
    Jimenez FJ, Grichnik JM, Buchanan HT, et al. Immunohistochemical techniques in Mohs micrographic surgery: their potential use in the detection of neoplastic cells masked by inflammation. J Am Acad Dermatol. 1995;32:89–94.CrossRefPubMedGoogle Scholar
  25. 25.
    Jimenez FJ, Grichnik JM, Buchanan MD, et al. Immunohistochemical margin control applied to Mohs micrographic surgical excision of dermatofibrosarcoma protuberans. J Dermatol Surg Oncol. 1994;20(10):687–689.PubMedGoogle Scholar
  26. 26.
    Zitelli JA, Brown C, Hanusa BH. Mohs micrographic surgery for the treatment of primary cutaneous melanoma. J Am Acad Dermatol. 1997;37(2 Pt 1):236–245.CrossRefPubMedGoogle Scholar
  27. 27.
    Bricca GM, Brodland DG, Ren D, Zitelli JA. Cutaneous head and neck melanoma treated with Mohs micrographic surgery. J Am Acad Dermatol. 2005 Jan;52(1):92–100.CrossRefPubMedGoogle Scholar
  28. 28.
    Hendi A, Brodland DG, Zitelli JA. Melanocytes in long-standing sun-exposed skin- quantitative analysis using the MART-1 immunostain. Arch Dermatol. 2006;142:871–876.CrossRefPubMedGoogle Scholar
  29. 29.
    Zalla MJ, Lim KK, Dicaudo DJ, Gagnot MM. Mohs micrographic excision of melanoma using immunostains. Dermatol Surg. 2000 Aug;26(8):771–784.CrossRefPubMedGoogle Scholar
  30. 30.
    Albertini G, Elston DM, Libow LF, et al. 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(8):656–665.Google Scholar
  31. 31.
    Melanoma clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2004;2:46–60.Google Scholar
  32. 32.
    Walling HW, Scupham RK, Bean AK, et al. Staged excision vs Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma. J Am Acad Dermatol. 2007 Oct;57(4):659–664.CrossRefPubMedGoogle Scholar
  33. 33.
    Johnson TM, Headington JT, Baker SR, et al. Usefulness of the staged excision for lentigo maligna and lentigo maligna melanoma: the “square” procedure. J Am Acad Dermatol. 1997;37:758–764.CrossRefPubMedGoogle Scholar
  34. 34.
    Hurst EA, Grekin RC, Yu SS, et al. Infectious complications and antibiotic use in dermatologic surgery. Semin Cutan Med Surg. 2007;26(1):47–53.CrossRefPubMedGoogle Scholar
  35. 35.
    Furoryan T, Grande D. Postoperative wound infection rates in dermatologic surgery. Dermatol Surg. 1995;21(6):509–514.CrossRefGoogle Scholar
  36. 36.
    Smack DP, Harrington AC, Dunn C, et al. Infection and allergy incidence in ambulatory surgery patients using white petrolatum vs bacitracin ointment: a randomized controlled trial. JAMA. 1996;25(12):972–977.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Desiree Ratner
    • 1
  • Jennifer L. MacGregor
    • 1
  1. 1.Department of DermatologyColumbia University Medical CenterNew YorkUSA

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