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Mohs Micrographic Surgery

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Book cover Skin Cancer

Part of the book series: Current Clinical Pathology ((CCPATH))

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Abstract

Mohs micrographic surgery (MMS) provides the highest cure rate for skin cancer while maximally sparing surrounding healthy tissue. False negatives and false positives are avoided by histologic studies of 100 % of the tumour margins and by sophisticated processing of horizontal sections during surgery, respectively. By sparing noncancerous tissue, MMS offers a solution to the dilemma of removing a tumour in its entirety while preserving as much tissue as possible intact. Since interactive microscopic control of removed tissue means that the neoplasm can be eliminated in stages, cure is theoretically confirmed by the end of surgery, depending on the type and characteristics of the removed tumour.

MMS success mainly depends on correctly performing a number of steps between removing the cancerous tissue and obtaining samples for histologic study. Errors in technique and microscopic interpretation are particularly relevant to cases of tumour recurrence after MMS. Therefore, in addition to mastering the basic principles of surgical dermatology, the Mohs surgeon needs to be trained in advanced MMS.

MMS is underpinned by two basic principles. The first principle is that microscopic confirmation of tumour-free surgical margins immediately on removing the tumour is far more specific than any visual inspection. The second principle concerns the need for coordination, as MMS is a single procedure performed in stages. Since a number of disciplines are involved, successful MMS requires one person—the Mohs surgeon—to assume responsibility for organising the procedure and ensuring effective communication when different tasks are carried out by different professionals. The Mohs surgeon thus needs to be knowledgeable about all the steps so as to oversee them and intervene interactively when necessary. Each of the MMS stages is reviewed in detail.

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Author information

Authors and Affiliations

  1. Department of Dermatology, Universitat Autònoma de Barcelona, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret, 167, Barcelona, Spain

    Joan Ramon Garcés MD

Authors
  1. Joan Ramon Garcés MD
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Correspondence to Joan Ramon Garcés MD .

Editor information

Editors and Affiliations

  1. and Pharmaceutical Sciences and Technologies, Second University of Naples Department of Environmental, Biological, Naples, Italy

    Alfonso Baldi

  2. Department of Dermatology, Pius Hospital de Valls, Valls, Tarragona, Spain

    Paola Pasquali

  3. S.A.F.U. Department, Regina Elena Cancer Institute, Rome, Italy

    Enrico P Spugnini

Glossary

Cryostat

is a device used to maintain low temperatures of samples

MART-1

Melanoma antigen recognised by T-cells

MMS

Mohs micrographic surgery

NMSC

Non-melanoma skin cancer

OCT

Optimal cutting temperature

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Garcés, J.R. (2014). Mohs Micrographic Surgery. In: Baldi, A., Pasquali, P., Spugnini, E. (eds) Skin Cancer. Current Clinical Pathology. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4614-7357-2_21

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  • DOI: https://doi.org/10.1007/978-1-4614-7357-2_21

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  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-4614-7356-5

  • Online ISBN: 978-1-4614-7357-2

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