Mohs technique is a precise method for removing skin tumors that, during excision, preserves healthy tissue. Common skin tumors treated with this technique are squamous and basal cell carcinoma. The American College of Mohs Surgery has established guidelines for the use of the technique. Tumor localization, patient characteristics, and tumor features should be considered when assessing whether this technique is the right choice. It’s useful in regions such as eyelids, lips and genitals. There are no absolute contraindications for the use of the Mohs technique. Before the surgery, a discussion with the patient should take place, a physical examination focusing on the tumor, and insight into the patient’s medical records should be obtained. During the preoperative period, the nature of the tumor should be explained to the patient, and the entire procedure should be described. The surgical instruments, operating room, and laboratory for processing and examining tissue under microscope are necessary for performing the technique. The intervention is usually done under local anesthesia with protective margin of 1 - 5 mm. After excision, the specimen is processed and examined under a microscope. If microscopic examination reveals the presence of tumor tissue on the edges, the excision process is repeated until the tumor is completely removed. Wound infection, bleeding, hematomas, wound dehiscence, and the development of hypertrophic or keloid scars are complications. The Mohs technique is a precise procedure used for treating skin tumors, verifying the entire tumor margin and preserving the maximum amount of healthy tissue.
Cite this paper
Vla?i?, M. , Jel?i?, S. , Be?enji, I. and Smiljani?, I. (2024). Mohs Micrographic Surgery Technique. Open Access Library Journal, 11, e1247. doi: http://dx.doi.org/10.4236/oalib.1111247.
Mohs, F.E. (1978) Chemosurgery for the Microscopically Controlled Excision of Cutaneous Cancer. Head & Neck Surgery, 1, 150-166.
https://doi.org/10.1002/hed.2890010209
Connolly, S.M., Baker, D.R., Coldiron, B.M., Fazio, M.J., Storrs, P.A., Vidimos, A.T., et al. (2012) AAD/ACMS/ASDSA/ASMS 2012 Appropriate Use Criteria for Mohs Micrographic Surgery: A Report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery. Journal of the American Academy of Dermatology, 67, 531-550. https://doi.org/10.1016/j.jaad.2012.06.009
Connolly, S.M., Baker, D.R., Coldiron, B.M., Fazio, M.J., Storrs, P.A., Vidimos, A.T., et al. (2012) AAD/ACMS/ASDSA/ASMS 2012 Appropriate Use Criteria for Mohs Micrographic Surgery: A Report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery. Dermatologic Surgery, 38, 1582-1603. https://doi.org/10.1111/j.1524-4725.2012.02574.x
Wong, E., Axibal, E. and Brown, M. (2019) Mohs Micrographic Surgery. Facial Plastic Surgery Clinics of North America, 27, 15-34.
https://doi.org/10.1016/j.fsc.2018.08.002
Horner, K.L. and Gasbarre, C.C. (2011) Special Considerations for Mohs Micrographic Surgery on the Eyelids, Lips, Genitalia, and Nail Unit. Dermatologic Clinics, 29, 311-317. https://doi.org/10.1016/j.det.2011.01.005
Holmkvist, K.A. and Roenigk, R.K. (1998) Squamous Cell Carcinoma of the Lip Treated with Mohs Micrographic Surgery: Outcome at 5 Years. Journal of the American Academy of Dermatology, 38, 960-966.
https://doi.org/10.1016/S0190-9622(98)70160-4
Shindel, A.W., Mann, M.W., Lev, R.Y., et al. (2007) Mohs Micrographic Surgery for Penile Cancer: Management and Long-Term Followup. The Journal of Urology, 178, 1980-1985. https://doi.org/10.1016/j.juro.2007.07.039
Dika, E., Fanti, P.A., Patrizi, A., et al. (2015) Mohs Surgery for Squamous Cell Carcinoma of the Nail Unit: 10 Years of Experience. Dermatologic Surgery, 41, 1015-1019. https://doi.org/10.1097/DSS.0000000000000452
Goldminz, D. and Bennett, R.G. (1992) Mohs Micrographic Surgery of the Nail Unit. The Journal of Dermatologic Surgery and Oncology, 18, 721-726.
https://doi.org/10.1111/j.1524-4725.1992.tb02006.x
Sharon, V.R., Armstrong, A.W., Jim On, S.C., et al. (2013) Separate-Versus Same-Day Preoperative Consultation in Dermatologic Surgery: A Patient-Centered Investigation in an Academic Practice. Dermatologic Surgery, 39, 240-247.
https://doi.org/10.1111/dsu.12083
Knackstedt, T.J. and Samie, F.H. (2015) Shared Medical Appointments for the Preoperative Consultation Visit of Mohs Micrographic Surgery. Journal of the American Academy of Dermatology, 72, 340-344.
https://doi.org/10.1016/j.jaad.2014.10.022
Delaney, A., Diamantis, S. and Marks, V.J. (2011) Complications of Tissue Ischemia in Dermatologic Surgery. Dermatologic Therapy, 24, 551-557.
https://doi.org/10.1111/j.1529-8019.2012.01459.x
Wright, T.I., Baddour, L.M., Berbari, E.F., et al. (2008) Antibiotic Prophylaxis in Dermatologic Surgery: Advisory Statement 2008. Journal of the American Academy of Dermatology, 59, 464-473. https://doi.org/10.1016/j.jaad.2008.04.031
T?nnesen, H., Nielsen, P.R., Lauritzen, J.B., et al. (2009) Smoking and Alcohol Intervention before Surgery: Evidence for Best Practice. British Journal of Anaesthesia, 102, 297-306. https://doi.org/10.1093/bja/aen401
Goldminz, D. and Bennett, R.G. (1991) Cigarette Smoking and Flap and Full-Thickness Graft Necrosis. Archives of Dermatology, 127, 1012-1015.
https://doi.org/10.1001/archderm.1991.01680060086009
Chang, L.K. and Whitaker, D.C. (2001) The Impact of Herbal Medicines on Dermatologic Surgery. Dermatologic Surgery, 27, 759-763.
https://doi.org/10.1046/j.1524-4725.2001.01089.x
Dinehart, S.M. and Henry, L. (2005) Dietary Supplements: Altered Coagulation and Effects on Bruising. Dermatologic Surgery, 31, 819-826.
https://doi.org/10.1111/j.1524-4725.2005.31726
Callahan, S., Goldsberry, A., Kim, G., et al. (2012) The Management of Antithrombotic Medication in Skin Surgery. Dermatologic Surgery, 38, 1417-1426.
https://doi.org/10.1111/j.1524-4725.2012.02490.x
Henley, J. and Brewer, J.D. (2013) Newer Hemostatic Agents Used in the Practice of Dermatologic Surgery. Dermatology Research and Practice, 2013, Article ID: 279289. https://doi.org/10.1155/2013/279289
Nemeth, S.A. and Lawrence, N. (2012) Site Identification Challenges in Dermatologic Surgery: A Physician Survey. Journal of the American Academy of Dermatology, 67, 262-268. https://doi.org/10.1016/j.jaad.2012.03.016
Humphreys, T.R., Shah, K., Wysong, A., et al. (2017) The Role of Imaging in the Management of Patients with Nonmelanoma Skin Cancer: When Is Imaging Necessary? Journal of the American Academy of Dermatology, 76, 591-607.
https://doi.org/10.1016/j.jaad.2015.10.009
Ravitskiy, L., Phillips, P.K., Roenigk, R.K., et al. (2011) The Use of Oral Midazolam for Perioperative Anxiolysis of Healthy Patients Undergoing Mohs Surgery: Conclusions from Randomized Controlled and Prospective Studies. Journal of the American Academy of Dermatology, 64, 310-322.
https://doi.org/10.1016/j.jaad.2010.02.038
McGinness, J.L. and Goldstein, G. (2010) The Value of Preoperative Biopsy-Site Photography for Identifying Cutaneous Lesions. Dermatologic Surgery, 36, 194-197.
https://doi.org/10.1111/j.1524-4725.2009.01426.x
Tajirian, A. and Tsui, M. (2016) Central Forehead Reconstruction with a Simple Primary Vertical Linear Closure. The Journal of Clinical and Aesthetic Dermatology, 9, 47-49.
Huang, C.C., Boyce, S., Northington, M., et al. (2004) Randomized, Controlled Surgical Trial of Preoperative Tumor Curettage of Basal Cell Carcinoma in Mohs Micrographic Surgery. Journal of the American Academy of Dermatology, 51, 585-591.
https://doi.org/10.1016/j.jaad.2004.04.009
Chung, V.Q., Bernardo, L. and Jiang, S.B. (2005) Presurgical Curettage Appropriately Reduces the Number of Mohs Stages by Better Delineating the Subclinical Extensions of Tumor Margins. Dermatologic Surgery, 31, 1094-1100.
https://doi.org/10.1097/00042728-200509000-00002
Ratner, D. and Bagiella, E. (2003) The Efficacy of Curettage in Delineating Margins of Basal Cell Carcinoma before Mohs Micrographic Surgery. Dermatologic Surgery, 29, 899-903. https://doi.org/10.1046/j.1524-4725.2003.29272.x
Rapini, R.P. (1990) Comparison of Methods for Checking Surgical Margins. Journal of the American Academy of Dermatology, 23, 288-294.
https://doi.org/10.1016/0190-9622(90)70212-Z
Krishnan, A., Xu, T., Hutfless, S., Park, A., Stasko, T., Vidimos, A.T., Leshin, B., Coldiron, B.M., Bennett, R.G., Marks, V.J., Brandt, R., Makary, M.A., Albertini, J.G. and the American College of Mohs Surgery Improving Wisely Study Group (2017) Outlier Practice Patterns in Mohs Micrographic Surgery: Defining the Problem and a Proposed Solution. JAMA Dermatology, 153, 565-570.
https://doi.org/10.1001/jamadermatol.2017.1450
Alam, M., Ibrahim, O., Nodzenski, M., et al. (2013) Adverse Events Associated with Mohs Micrographic Surgery: Multicenter Prospective Cohort Study of 20,821 Cases at 23 Centers. JAMA Dermatology, 149, 1378-1385.
https://doi.org/10.1001/jamadermatol.2013.6255