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Mohs surgery

Indications: 1) recurrent basal cell carcinoma (BCC) 2) large (> 2 cm) BCC 3) morpheaform (sclerosing) BCC 4) BCC in locations where embryonic tissue planes fuse a) central areas of the face 1] nasolabial folds 2] lateral & medial canthi b) behind, in & around the ears (pre- & retro-auricular) Procedure: - microscopically-controlled surgery enabling the extent of the tumor (basal cell carcinoma) to be determined at the time of surgery - topical decolonization of Staphylococcus aureus carriers results in fewer surgical site infections than prophylactic antibiotics [5] Notes: - 18% positive-margin rate after excision of BCC with 3-mm margins suggests that wider margins should be used for excising high-risk primary BCCs [4]

Related

basal cell carcinoma (BCC)

General

dermatologic surgery microscope-enabled surgery

References

  1. Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 216
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  3. Essers BA et al, Cost-effectiveness of Mohs micrographic surgery vs surgical excision for basal cell carcinoma of the face. Arch Dermatol 2006; 142:187 PMID: 16490846
  4. Mosterd K et al. Surgical excision versus Mohs' micrographic surgery for primary and recurrent basal-cell carcinoma of the face: A prospective randomised controlled trial with 5-years' follow-up. Lancet Oncol 2008 Dec; 9:1149. PMID: 19010733
  5. Cherian P et al. Oral antibiotics versus topical decolonization to prevent surgical site infection after Mohs micrographic surgery - A randomized, controlled trial. Dermatol Surg 2013 Oct; 39:1486 PMID: 24090258
  6. Connolly SM, Baker DR, Coldiron BM et al 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. Dermatol Surg. 2012 Oct;38(10):1582-603. PMID: 22958088
  7. Etzkorn JR, Alam M What Is Mohs Surgery? JAMA Dermatology Patient Page. May 6, 2020 (video) PMID: 32374349 https://jamanetwork.com/journals/jamadermatology/fullarticle/2764796