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Histopathologic pitfalls of Mohs micrographic surgery and a review of tumor histology

Histopathologische Fallstricke der mikrographischen Chirurgie nach Mohs und Übersicht über die Tumorhistologie

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Summary

Mohs micrographic surgery is a specialized subset of staged surgical excisions with each subsequent stage being driven largely by the histologic findings of the previous stage. Therefore, it is imperative that histologic analysis is performed in an accurate manner. Frozen section and tissue flattening is a crucial step in Mohs surgery. Frozen sections introduce certain artifacts and these artifacts must be interpreted in the correct context. Basal and squamous cell carcinomas are the most common tumors encountered in Mohs micrographic surgery, and their histopathology is also associated with certain “pitfalls”. Basal cell carcinoma should be distinguished from hair follicles, folliculocentric basaloid proliferations, poromas, nevus sebaceous, desmoplastic trichoepitheliomas, and spiradenomas, to name but a few histologic entities. Similarly, squamous cell carcinoma should be distinguished from hypertrophic actinic keratoses, pseudoepitheliomatous hyperplasia, sebaceous carcinoma, and microcystic adnexal carcinoma. In addition, there are numerous subtypes of basal cell and squamous carcinomas that the Mohs surgeon should be aware of due to differences in the biologic behavior of these tumors. This review presents a number of the common histologic pitfalls of Mohs micrographic surgery and a review of tumor histology.

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Authors and Affiliations

  1. Department of Dermatology & Cutaneous Surgery, Department of Psychiatry & Behavioral Sciences, Institute for Bioethics & Health Policy, University of Miami Miller School of Medicine, Miami, FL, USA

    Katlein França M.D, Ph.D

  2. Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA

    Yasser Alqubaisy M.D & Keyvan Nouri M.D

  3. Centro Studi per la Ricerca Multidisciplinare e Rigenerativa, Università Degli Studi “G. Marconi”, Rome, Italy

    Katlein França M.D, Ph.D & Torello Lotti M.D

  4. Dermatopathology Department, Florida Dermatalogic Surgery & Aesthetics Institute, The Villages, FL, USA

    Ashraf Hassanein M.D, Ph.D

  5. Chair of Dermatology, University of Rome “G.Marconi”, Rome, Italy

    Torello Lotti M.D

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  1. Katlein França M.D, Ph.D
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Correspondence to Katlein França M.D, Ph.D.

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K. França, Y. Alqubaisy, A. Hassanein, K. Nouri, and T. Lotti declare that they have no competing interests.

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França, K., Alqubaisy, Y., Hassanein, A. et al. Histopathologic pitfalls of Mohs micrographic surgery and a review of tumor histology. Wien Med Wochenschr 168, 218–227 (2018). https://doi.org/10.1007/s10354-016-0528-0

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