Abstract
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.
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References
Mohs FE. Chemosurgery: a microscopically controlled method of cancer excision. Arch Surg. 1941;42:279–295.
Drake LA, Dinehart SM, Goltz RW, et al. Guidelines of care for Mohs micrographic surgery. J Am Acad Dermatol. 1995;33:271–278.
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.
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.
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.
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.
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.
Mohs FE. Chemosurgery: microscopically controlled surgery for skin cancer—past, present and future. J Dermatol Surg Oncol. 1978;4:41–54.
Mohs FE. Chemosurgery for the microscopically controlled excision of cutaneous cancer. Head Neck Surg. 1978;1:150–163.
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.
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.
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.
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.
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.
Alcalay J, Alkalay R. Controversies in perioperative management of blood thinners in dermatologic surgery: continue or discontinue? Dermatol Surg. 2004;30(8):1091–1094.
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.
Wilson W, Taubert KA, Gewitz M, et al. Prevention of Infective Endocarditis Guidelines From the American Heart Association. Circulation. 2007;116:1736–1754.
American Academy of Orthopaedic Surgeons Advisory Statement on Antibiotic Prophylaxis for Dental Patients with Total Joint Replacements. http://www.aaos.org/about/papers/advistmt/1027.asp. Accessed 1/21/09.
Wright TI, Baddour LM, Berbari EF, et al. Antibiotic prophylaxis in dermatologic surgery: Advisory statement. J Am Acad Dermatol. 2008;59:464–473.
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.
Lee DA, Ratner D. Economic impact of preoperative curettage before mohs micrographic surgery for basal cell carcinoma. Dermatol Surg. 2006;32(7):916–923.
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.
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.
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.
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.
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.
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.
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.
Zalla MJ, Lim KK, Dicaudo DJ, Gagnot MM. Mohs micrographic excision of melanoma using immunostains. Dermatol Surg. 2000 Aug;26(8):771–784.
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.
Melanoma clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2004;2:46–60.
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.
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.
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.
Furoryan T, Grande D. Postoperative wound infection rates in dermatologic surgery. Dermatol Surg. 1995;21(6):509–514.
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.
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Ratner, D., MacGregor, J.L. (2009). Mohs Surgery. In: MacFarlane, D.F. (eds) Skin Cancer Management. Springer, New York, NY. https://doi.org/10.1007/978-0-387-88495-0_11
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DOI: https://doi.org/10.1007/978-0-387-88495-0_11
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