Mohs Micrographic Surgery Research Articles

Postoperative permanent section evaluation of Mohs micrographic surgery debulk specimens does not result in upstaging of cutaneous squamous cell carcinoma compared to stage at the completion of surgery: A retrospective case series

BackgroundMohs micrographic surgery (MMS) is used for the treatment of high-risk cutaneous squamous cell carcinoma (cSCC). MMS examines the surgical margins in real time and does not commonly examine the central component of the tumor. ObjectiveTo determine if debulk specimens provide additional details relevant to tumor staging not gained from routine MMS. MethodsA retrospective chart review of debulk specimens taken during MMS for cSCC was conducted. Dermatopathology reports were analyzed and tumors were staged using Brigham and Women's Hospital (BWH) and American Joint Committee on Cancer’s 8th edition (AJCC8) staging systems. ResultsPermanent section evaluation of debulk specimens did not result in clinically meaningful information for staging that could not be gained from MMS layers or initial biopsy analysis. LimitationsA single institution, and the small sample size of 39 tumors. ConclusionsEvaluation of debulk specimens during MMS may not always be an effective use of time or healthcare resources.

Outcomes of Mohs micrographic surgery for periocular squamous cell carcinoma.

Periocular cutaneous squamous cell carcinoma (cSCC) accounts for 5-10% of all eyelid malignancies. Periocular cSCC carries a low mortality rate but can be destructive to local tissues. Due to the unique function and anatomy of the eyelids, Mohs micrographic surgery (MMS) is gold standard for treating cSCC to preserve healthy tissue and reduce rates of local recurrence. In this study, we describe the success and outcomes of MMS and subsequent oculoplastic reconstruction for periocular cSCC in the North East of England. Retrospective analysis of 34 patients who underwent MMS for periocular cSCC in the North of England between 2013 and 2020. Primary outcome measure of success is defined as no recurrence of cSCC after minimum 24 months' time elapsed post-MMS. Secondary outcome measures included analysis of disease characteristics, describing the surgical techniques utilised for oculoplastic reconstruction following MMS and surgical complications should they occur. Two patients (5.9%) had local recurrence of periocular cSCC. Median time elapsed since MMS was 60 months. A variety of oculoplastic surgical techniques were utilised in the repair of the Mohs defect. One patient (2.9%) developed a significant post-operative reconstruction complication. Periocular cSCC recurrence following MMS in the North of England is 5.9%, which is comparable to the literature. Significant post-operative complications following oculoplastic reconstruction of periocular MMS are very low, occurring in 2.9% of cases in this study.

A Comparison of Preoperative Telephone Call Versus Mailed Educational Materials on Patient-Reported Outcomes in Mohs Micrographic Surgery.

Preoperative education has uncertain benefits on the preparedness and satisfaction of patients undergoing Mohs micrographic surgery (MMS). We sought to determine the effect of a preoperative telephone call on preparedness and satisfaction in patients undergoing same-day office consultation and MMS. All new patients ( N = 208) scheduled for same-day office consultation and MMS were mailed a standardized preoperative packet. Approximately half of those patients were randomly selected to also receive a preoperative phone call. On the day of the surgery, patients completed an anonymous preoperative and postoperative survey assessing their preparedness and satisfaction with the preoperative education received. There was no significant difference in patient preparedness between the letter only (LO) and phone call and letter study groups. There was a significant difference in preoperative satisfaction-a higher percentage of LO patients were "somewhat satisfied" or "not satisfied" with the preoperative education received ( p = .013). Preoperative phone consultation, in addition to mailed educational materials, did not have a statistically significant effect on patient preparedness in patients undergoing MMS; however, there was a trend toward increased satisfaction with the preoperative education provided in patients who received a preoperative phone call.

Exploring the potential role for extended reality in Mohs micrographic surgery.

Mohs micrographic surgery (MMS) is a cornerstone of dermatological practice. Virtual reality (VR) and augmented reality (AR) technology, initially used for entertainment, have entered healthcare, offering real-time data overlaying a surgeon's view. This paper explores potential applications of VR and AR in MMS, emphasizing their advantages and limitations. We aim to identify research gaps to facilitate innovation in dermatological surgery. We conducted a PubMed search using the following: "augmented reality" OR "virtual reality" AND "Mohs" or "augmented reality" OR "virtual reality" AND "surgery." Inclusion criteria were peer-reviewed articles in English discussing these technologies in medical settings. We excluded non-peer-reviewed sources, non-English articles, and those not addressing these technologies in a medical context. VR alleviates patient anxiety and enhances patient satisfaction while serving as an educational tool. It also aids physicians by providing realistic surgical simulations. On the other hand, AR assists in real-time lesion analysis, optimizing incision planning, and refining margin control during surgery. Both of these technologies offer remote guidance for trainee residents, enabling real-time learning and oversight and facilitating synchronous teleconsultations. These technologies may transform dermatologic surgery, making it more accessible and efficient. However, further research is needed to validate their effectiveness, address potential challenges, and optimize seamless integration. All in all, AR and VR enhance real-world environments with digital data, offering real-time surgical guidance and medical insights. By exploring the potential integration of these technologies in MMS, our study identifies avenues for further research to thoroughly understand the role of these technologies to redefine dermatologic surgery, elevating precision, surgical outcomes, and patient experiences.

A comparative analysis of keratoacanthomas and cutaneous squamous cell carcinoma treated with Mohs micrographic surgery

A comparative analysis of keratoacanthomas and cutaneous squamous cell carcinoma treated with Mohs micrographic surgery

Mohs micrographic surgery with magnet suspension of implantable cardioverter defibrillators.

Mohs micrographic surgery with magnet suspension of implantable cardioverter defibrillators.

Nasal Lining Repair: A Comprehensive Literature Review.

Currently, there are limited reviews in the dermatology literature on how to approach reconstruction of nasal lining in full-thickness nasal defects resulting from Mohs micrographic surgery. Given variable training and experience, dermatologic surgeons may seek additional references to help reconstruct certain advanced defects. We sought to synthesize literature from dermatologic surgery, plastic surgery, and otolaryngology to review repair options and considerations for repair of nasal lining defects. To present a comprehensive literature review of repair options for nasal lining reconstruction and discuss advantages, disadvantages, specific anatomic considerations, and techniques to execute such options. Articles from several different reconstructive specialties including dermatologic/Mohs surgery, otolaryngology, and plastic and reconstructive surgery were reviewed. Instructive images were compiled to illustrate several techniques, with additional medical illustration recreations included to help showcase important reconstructive approaches. A comprehensive descriptive review of nasal lining repair options for the reconstructive surgeon. Advanced tumors can result in full-thickness nasal defects, and this review describes various reconstructive options for reconstruction based on the extent of the defect.

Intraoperative margin assessment for basal cell carcinoma with deep learning and histologic tumor mapping to surgical site

Successful treatment of solid cancers relies on complete surgical excision of the tumor either for definitive treatment or before adjuvant therapy. Intraoperative and postoperative radial sectioning, the most common form of margin assessment, can lead to incomplete excision and increase the risk of recurrence and repeat procedures. Mohs Micrographic Surgery is associated with complete removal of basal cell and squamous cell carcinoma through real-time margin assessment of 100% of the peripheral and deep margins. Real-time assessment in many tumor types is constrained by tissue size, complexity, and specimen processing / assessment time during general anesthesia. We developed an artificial intelligence platform to reduce the tissue preprocessing and histological assessment time through automated grossing recommendations, mapping and orientation of tumor to the surgical specimen. Using basal cell carcinoma as a model system, results demonstrate that this approach can address surgical laboratory efficiency bottlenecks for rapid and complete intraoperative margin assessment.

Validation of the Webb and Rivera Score in Predicting Complexity of Mohs Surgery Procedures: A Retrospective Study

Background: Mohs micrographic surgeries (MMSs) vary in complexity and corresponding procedural duration. Preoperative triage of MMS cases enables physicians to estimate procedure duration and create an efficient schedule. The Webb and Rivera (WAR) score is a quantitative formula developed to predict complexity in Mohs cases based on tumor diameter, history of recurrence, location, and aggressiveness. Patients are given a score between 0 and 5 based on this information, with increasing surgical complexity for higher scores. Purpose: We aim to assess the association between WAR score, the number of stages, and repair type used in MMS to determine its value for clinical practice. Methods: Data for WAR score calculation were collected and analyzed for patients with squamous cell carcinoma and/or basal cell carcinoma treated with MMS between 2019 and 2023. Analyses were performed to determine if there was significant heterogeneity across WAR score groups. The Mantel–Haenszel Chi-square tests were performed for ordered categorical variables (Mohs stage), and Chi-square tests were performed for nonordered categorical variables. The results were verified using Fisher’s exact test when more than 25% of cells had an expected count of <5. Analyses were performed using SAS v9.4 (SAS Institute, Cary, NC). Results: Of the 712 patients who underwent MMS, 153 (21%) had a WAR score of 0, 270 (38%) had a WAR score of 1, 189 (26%) had a WAR score of 2, 75 (10%) had a WAR score of 3, 23 (3.2%) had a WAR score of 4, and 2 (0.2%) had a WAR score of 5. The average number of surgical stages increased as the WAR score increased, and the percentage of repairs using a flap or graft similarly increased for higher scores. While 86.2% of patients with a WAR score of 0 were cleared with one stage, this decreased to 75.5% with a score of 1, 74.6% with a score of 2, 72% with a score of 3, and 52.1% with a score of 4. Only two cases had a score of 5, both of which required two stages. In addition, only 13.7% of tumors with a WAR score of 0 required closure with a flap or graft, in comparison with 24.2% with a score of 1, 33.9% with a score of 2, 47.9% with a score of 3, and 47.7% with a score of 4. Conclusion: This study demonstrates that the WAR score is an effective predictive tool for identifying cases that may require multiple stages and more complex reconstructive techniques. Given that more complex cases will require increased operative time, a scheduling template that accounts for the level of complexity can lead to a more effective schedule. The WAR score may provide a practical tool for Mohs surgeons and their staff to triage incoming cases and design a schedule that allows for a consistent workflow.

Use of Collagen Powder in Secondary Intention Healing After Mohs Surgery or Excisional Surgery: A Retrospective Study

Background. Little is known about the usefulness of collagen powder in secondary intention healing in patients undergoing cutaneous surgery. Objective. To investigate the clinical outcomes associated with application of collagen powder in cutaneous surgery and patients’ perceptions of the procedure. Methods. A retrospective chart review of 266 patients who underwent Mohs surgery or excisional surgery at a single institution between January 2020 and January 2022, and who had secondary intention healing of wounds assisted by powdered collagen was conducted. Personal interviews were conducted with 63 of those patients (23.7%). Tumor characteristics, estimated healing times, and patient satisfaction were scored. The Vancouver Scar Scale and the Patient and Observer Scar Assessment Scale were used to assess the resulting wound bed. All data underwent statistical analysis. Results. Of 266 granulating wounds with an average defect size of 6.0 cm2, excisional surgery was performed in 143 (54%) and Mohs surgery in 123 (46%). Most procedures (92.1%) were undertaken for nonmelanoma skin cancers. The average healing time was 6.3 weeks. The mean patient score for ease of use and overall impression of collagen application was 8.2 on a scale of 1 to 10, with 10 being most favorable. Conclusion. When clinically appropriate, granulation assisted by collagen powder should be considered for augmenting secondary intention healing.

Correction to: Dehydrated human amnion/chorion membrane allograft for postoperative wounds following Mohs micrographic surgery: a retrospective comparative evaluation.

Introduction. Defects that remain after MMS cannot always be repaired immediately. When closure is not feasible, wounds are left to heal by secondary intention and may take weeks to close. In such cases, the use of an allograft that stimulates endogenous wound healing pathways may be desirable. Objective. This retrospective study assessed whether the use of dHACM allograft after MMS led to a statistically significant improvement in post-Mohs wound closure rates compared with secondary intention healing. Methods. This study evaluated 80 patients who underwent MMS and compared time to complete healing between wounds treated with dHACM allografts (n = 40) and wounds healed by secondary intention (n = 40). Wounds were assessed every 2 weeks, and photographs were taken. Statistical analysis was conducted. Results. Average time to complete wound healing was significantly reduced with the use of dHACM allograft compared with traditional secondary intention healing (5.2 weeks and 6.5 weeks, respectively; P = .01). Conclusion. The use of dHACM allograft resulted in more rapid wound healing, and this allograft is a potential alternative to traditional secondary intention healing methods. Further studies are needed to reinforce the results of this pilot study.

A-363 - Four years experience in Mohs Surgery

A-363 - Four years experience in Mohs Surgery

Store-and-Forward Teledermatology Wound Checks Following Mohs Surgery: A Pilot Study.

Store-and-forward telemedicine is a form of electronic transmission in which patient images or clinical information are transmitted to clinicians for asynchronous clinical decision making. This study evaluated the use, feasibility, savings, and patient satisfaction of postoperative store-and-forward wound checks following Mohs surgery. Select patients were asked to participate in a virtual postoperative wound check after receiving Mohs surgery. Participants sent photos of their wound site and subsequently completed an anonymous survey. One hundred and ten patients were enrolled, mean age 68 (range 32-87). Patients saved an average of $14.16, 78.6 miles of travel, and 90 min of travel time. Ninety-eight percent of respondents felt their quality of care in teledermatology was "about the same" to "much better" than compared with traditional in-person care. Sixty-four of the respondents (90.1%) reported they would prefer their next Mohs wound check to be conducted through teledermatology. Store-and-forward telemedicine in patients undergoing Mohs micrographic surgery is a safe, effective, and efficient method for postoperative wound care.

Rare Cutaneous Soft Tissue Sarcomas Treated With Slow Mohs Micrographic Surgery: Ten Years' Experience at a Single Institution.

Rare Cutaneous Soft Tissue Sarcomas Treated With Slow Mohs Micrographic Surgery: Ten Years' Experience at a Single Institution.

Mohs surgery for the treatment of eccrine spiroadenoma: a case report

Mohs surgery for the treatment of eccrine spiroadenoma: a case report

Predictors for Preoperative Anxiety in Patients Undergoing Mohs Micrographic Surgery for the First Time: A Prospective Cohort Study

Predictors for Preoperative Anxiety in Patients Undergoing Mohs Micrographic Surgery for the First Time: A Prospective Cohort Study

A Review for Dermatofibrosarcoma Protuberans

Dermatofibrosarcoma protuberans (DFSP) stands as the most prevalent cutaneous sarcoma, marked by slow growth and a protuberant papulonodular appearance. Although rare, its impact is significant, necessitating a comprehensive understanding of its characteristics and optimal management. DFSP typically affects adults, though age variability exists, presenting diagnostic challenges. Histological evaluation, often utilizing CD34 immunohistochemical staining, is crucial for accurate diagnosis. The primary treatment modality remains complete surgical excision, emphasizing the importance of generous margins. Imatinib emerges as a valuable therapeutic option for unresectable or metastatic cases. Complementary approaches such as adjuvant radiation therapy and Mohs surgery enhance the treatment armamentarium, allowing for a tailored, multidisciplinary strategy. Regular follow-up is essential for monitoring and addressing potential complications. While local recurrence is a concern, DFSP generally carries a favorable prognosis, especially with early detection and appropriate intervention. Ongoing research continues to refine treatment paradigms, promising improved outcomes for individuals affected by this distinctive cutaneous sarcoma.

Family Planning Experiences and Challenges of Mohs Fellowship Trainees.

There is a paucity of literature describing family planning challenges faced by Mohs fellows. To characterize perceptions about and experiences with family planning, fertility, lactation, and parental leave and identify ways to support parental health and family planning for Mohs fellows. A voluntary, anonymous survey was distributed to Mohs surgeons who recently completed fellowship. In total, 116 Mohs surgeons completed the survey. Their mean age was 34.5 years old, and more were female ( n = 81, 69.8%) than male ( n = 35, 30.2%). Most had children before completion of their Mohs training ( n = 73, 62.9%). The most significant barrier to having children during fellowship was "loss of education or training time." Over 20% ( n = 23) of respondents or their partner had experienced infertility. Half of the 20 respondents ( n = 10) who breastfed or pumped did not have a convenient place to do so. This study elucidates trainee perceptions and gaps in parental support for Mohs fellowship trainees. In addition, barriers to implementing a universal family planning policy in Mohs surgery are discussed.

Implementation of Mohs micrographic surgery at the VA New York Manhattan Harbor Healthcare System eliminated need for re-excision and decreased time to treatment: A retrospective and prospective cohort study

Implementation of Mohs micrographic surgery at the VA New York Manhattan Harbor Healthcare System eliminated need for re-excision and decreased time to treatment: A retrospective and prospective cohort study

Young Man With Primary Mucinous Cell Carcinoma ofthe Eyelid: 36 Month Follow Up.

Primary cutaneous mucinous carcinoma (PCMC) is a malignant adnexal tumor that masquerades as a benign periocular lesion. We present a case of a 29-year-old male with an eyelid PCMC misdiagnosed as a chalazion. He underwent Mohs microscopic surgery for definitive treatment, with no recurrence at his 36 month follow up. Given the rarity and poorer prognosis in younger patients, a high index of suspicion is crucial for biopsying periocular lesions that fail conservative therapy.