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Mohs Surgery

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Evidence-Based Procedural Dermatology

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Abstract

In the early 1940s, Dr. Frederic Mohs first published a technique for the removal of skin cancers utilizing in vivo tissue fixation by the application of a zinc chloride paste directly to the skin, followed by excision and specimen mounting for histologic evaluation the next day. The procedure was based on the principles that cutaneous malignancies grow in a contiguous manner from a central origin and complete removal is necessary and sufficient for tumor local tumor control. Since that time the practice of Mohs micrographic surgery (MMS) has evolved into the fresh tissue technique with frozen sections. This procedure omits fixation of the tissue in situ prior to excision and rapidly processes the tissue after excision using an embedding medium and a cryostat to freeze and section the specimen prior to histologic staining. MMS is divided into two phases: surgery and pathology. There are great variations in technique among Mohs surgeons regarding tumor debulking, the removal of layers and the marking of specimens. The common elements for all Mohs procedures include a clinical delineation of tumor margins, removal of the clinical tumor with 1–3 mm margins with a disc or saucer shape, marking of the tumor bed to allow correlation of the surgical site with the excised specimen, and mapping of the specimen. During mapping, the tissue is cut into appropriate pieces and the edges are dyed with different colored inks to identify individual margins. The colors are coded to the corresponding edges on the tissue map.

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References

  1. Drake LA, Dinehart SM, Goltz RW, Graham GF, Hordinsky MK, Lewis CW, et al. Guidelines of care for Mohs micrographic surgery. American Academy of Dermatology. J Am Acad Dermatol. 1995;33:271–8.

    Article  PubMed  CAS  Google Scholar 

  2. Telfer NR, Colver GB, Bowers PW. Guidelines for the management of basal cell carcinoma. British Association of Dermatologists. Br J Dermatol. 1999; 141:415–23.

    Article  PubMed  CAS  Google Scholar 

  3. http://www.nccn.org/professionals/physician_gls/default.asp. Accessed August 30, 2011.

  4. Miller PK, Roenigk RK, Brodland DG, Randle HW. Cutaneous micrographic surgery: Mohs procedure. Mayo Clin Proc. 1992;67:971–80.

    PubMed  CAS  Google Scholar 

  5. Iriondo M. Mohs micrographic surgery. Compr Ther. 1994;20:369–74.

    PubMed  CAS  Google Scholar 

  6. Kumar B, Roden D, Vinciullo C, Elliott T. A review of 24 cases of Mohs surgery and ophthalmic plastic reconstruction. Aust N Z J Ophthalmol. 1997;25: 289–93.

    Article  PubMed  CAS  Google Scholar 

  7. Essers BA, Dirksen CD, Nieman FH, Smeets NW, Krekels GA, Prins MH, et al. Cost-effectiveness of Mohs micrographic surgery vs surgical excision for basal cell carcinoma of the face. Arch Dermatol. 2006;142:187–94.

    Article  PubMed  Google Scholar 

  8. Bialy TL, Whalen J, Veledar E, Lafreniere D, Spiro J, Chartier T, et al. Mohs micrographic surgery vs traditional surgical excision: a cost comparison analysis. Arch Dermatol. 2004;140:736–42.

    Article  PubMed  Google Scholar 

  9. Lang Jr PG, Osguthorpe JD. Indications and limitations of Mohs micrographic surgery. Dermatol Clin. 1989;7:627–44.

    PubMed  Google Scholar 

  10. Lambert DR, Siegle RJ. Skin cancer: a review with consideration of treatment options including Mohs micrographic surgery. Ohio Med. 1990;86:745–7.

    PubMed  CAS  Google Scholar 

  11. Leslie DF, Greenway HT. Mohs micrographic surgery for skin cancer. Australas J Dermatol. 1991;32:159–64.

    Article  PubMed  CAS  Google Scholar 

  12. Rowe DE, Carroll RJ, Day Jr CL. Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up. J Dermatol Surg Oncol. 1989;15:315–28.

    PubMed  CAS  Google Scholar 

  13. Shriner DL, McCoy DK, Goldberg DJ, Wagner Jr RF. Mohs micrographic surgery. J Am Acad Dermatol. 1998;39:79–97.

    Article  PubMed  CAS  Google Scholar 

  14. Rippey JJ, Rippey E. Characteristics of incompletely excised basal cell carcinomas of the skin. Med J Aust. 1997;166:581–3.

    PubMed  CAS  Google Scholar 

  15. Pascal RR, Hobby LW, Lattes R, Crikelair GF. Prognosis of “incompletely excised” versus “completely excised” basal cell carcinoma. Plast Reconstr Surg. 1968;41:328–32.

    Article  PubMed  CAS  Google Scholar 

  16. Cataldo PA, Stoddard PB, Reed WP. Use of frozen section analysis in the treatment of basal cell carcinoma. Am J Surg. 1990;159:561–3.

    Article  PubMed  CAS  Google Scholar 

  17. Farhi D, Dupin N, Palangie A, Carlotti A, Avril MF. Incomplete excision of basal cell carcinoma: rate and associated factors among 362 consecutive cases. Dermatol Surg. 2007;33:1207–14.

    Article  PubMed  CAS  Google Scholar 

  18. Wolf DJ, Zitelli JA. Surgical margins for basal cell carcinoma. Arch Dermatol. 1987;123:340–4.

    Article  PubMed  CAS  Google Scholar 

  19. Hruza GJ. Mohs micrographic surgery local recurrences. J Dermatol Surg Oncol. 1994;20:573–7.

    PubMed  CAS  Google Scholar 

  20. Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R. Basal cell carcinoma treated with Mohs surgery in Australia II. Outcome at 5-year follow-up. J Am Acad Dermatol. 2005;53:452–7.

    Article  PubMed  Google Scholar 

  21. Leibovitch I, Huilgol SC, Selva D, Hill D, Richards S, Paver R. Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia I. Experience over 10 years. J Am Acad Dermatol. 2005;53:253–60.

    Article  PubMed  Google Scholar 

  22. Rowe DE, Carroll RJ, Day Jr CL. Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. Implications for treatment modality selection. J Am Acad Dermatol. 1992;26:976–90.

    Article  PubMed  CAS  Google Scholar 

  23. Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R. Cutaneous squamous carcinoma in situ (Bowen’s disease): treatment with Mohs micrographic surgery. J Am Acad Dermatol. 2005;52:997–1002.

    Article  PubMed  Google Scholar 

  24. Julian CG, Bowers PW. A prospective study of Mohs’ micrographic surgery in two English centres. Br J Dermatol. 1997;136:515–8.

    Article  PubMed  CAS  Google Scholar 

  25. Mohs FE. Chemosurgery: microscopically controlled surgery for skin cancer – past, present and future. J Dermatol Surg Oncol. 1978;4:41–54.

    PubMed  CAS  Google Scholar 

  26. Mohs FE. Chemosurgery for the microscopically controlled excision of cutaneous cancer. Head Neck Surg. 1978;1:150–66.

    Article  PubMed  CAS  Google Scholar 

  27. Mohs F. Chemosurgery: microscopically controlled surgery for skin cancer. Springfield: Charles C. Thomas; 1978.

    Google Scholar 

  28. Robins P. Chemosurgery: my 15 years of experience. J Dermatol Surg Oncol. 1981;7:779–89.

    PubMed  CAS  Google Scholar 

  29. Robins P, Dzubow LM, Rigel DS. Squamous-cell carcinoma treated by Mohs’ surgery: an experience with 414 cases in a period of 15 years. J Dermatol Surg Oncol. 1981;7:800–1.

    PubMed  CAS  Google Scholar 

  30. Dzubow LM. Chemosurgical report: recurrence (persistence) of tumor following excision by Mohs surgery. J Dermatol Surg Oncol. 1987;13:27–30.

    PubMed  CAS  Google Scholar 

  31. Campbell RM, Barrall D, Wilkel C, Robinson-Bostom L, Dufresne RG, Jr. Post-Mohs micrographic surgical margin tissue evaluation with permanent histopathologic sections. Dermatol Surg. 2005;31:655–8; discussion 8.

    Google Scholar 

  32. Smeets NW, Kuijpers DI, Nelemans P, Ostertag JU, Verhaegh ME, Krekels GA, et al. Mohs’ micrographic surgery for treatment of basal cell carcinoma of the face – results of a retrospective study and review of the literature. Br J Dermatol. 2004;151:141–7.

    Article  PubMed  CAS  Google Scholar 

  33. Feasel AM, Brown TJ, Bogle MA, Tschen JA, Nelson BR. Perineural invasion of cutaneous malignancies. Dermatol Surg. 2001;27:531–42.

    Article  PubMed  CAS  Google Scholar 

  34. Mohs FE, Lathrop TG. Modes of spread of cancer of skin. AMA Arch Derm Syphilol. 1952;66:427–39.

    PubMed  CAS  Google Scholar 

  35. Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R. Basal cell carcinoma treated with Mohs surgery in Australia III. Perineural invasion. J Am Acad Dermatol. 2005;53:458–63.

    Article  PubMed  Google Scholar 

  36. Ratner D, Lowe L, Johnson TM, Fader DJ. Perineural spread of basal cell carcinomas treated with Mohs micrographic surgery. Cancer. 2000;88:1605–13.

    Article  PubMed  CAS  Google Scholar 

  37. Hanke CW, Wolf RL, Hochman SA, O’Brian JJ. Chemosurgical reports: perineural spread of basal-cell carcinoma. J Dermatol Surg Oncol. 1983;9: 742–7.

    PubMed  CAS  Google Scholar 

  38. Leibovitch I, Huilgol SC, Selva D, Hill D, Richards S, Paver R. Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia II. Perineural invasion. J Am Acad Dermatol. 2005;53: 261–6.

    Article  PubMed  Google Scholar 

  39. Cottel WI. Perineural invasion by squamous-cell ­carcinoma. J Dermatol Surg Oncol. 1982;8:589–600.

    PubMed  CAS  Google Scholar 

  40. Goepfert H, Dichtel WJ, Medina JE, Lindberg RD, Luna MD. Perineural invasion in squamous cell skin carcinoma of the head and neck. Am J Surg. 1984;148: 542–7.

    Article  PubMed  CAS  Google Scholar 

  41. Ballantyne AJ, McCarten AB, Ibanez ML. The extension of cancer of the head and neck through peripheral nerves. Am J Surg. 1963;106:651–67.

    Article  PubMed  CAS  Google Scholar 

  42. Malhotra R, Huilgol SC, Huynh NT, Selva D. The Australian Mohs database, part II: periocular basal cell carcinoma outcome at 5-year follow-up. Ophthalmology. 2004;111:631–6.

    Article  PubMed  Google Scholar 

  43. Malhotra R, Huilgol SC, Huynh NT, Selva D. The Australian Mohs database: periocular squamous cell carcinoma. Ophthalmology. 2004;111:617–23.

    Article  PubMed  Google Scholar 

  44. Robins P, Rodriguez-Sains R, Rabinovitz H, Rigel D. Mohs surgery for periocular basal cell carcinomas. J Dermatol Surg Oncol. 1985;11:1203–7.

    PubMed  CAS  Google Scholar 

  45. Mohs FE. Micrographic surgery for the microscopically controlled excision of eyelid cancers. Arch Ophthalmol. 1986;104:901–9.

    PubMed  CAS  Google Scholar 

  46. Ceilley RI, Anderson RL. Microscopically controlled excision of malignant neoplasms on and around eyelids followed by immediate surgical reconstruction. J Dermatol Surg Oncol. 1978;4:55–62.

    PubMed  CAS  Google Scholar 

  47. Arlette JP, Carruthers A, Threlfall WJ, Warshawski LM. Basal cell carcinoma of the periocular region. J Cutan Med Surg. 1998;2:205–8.

    PubMed  CAS  Google Scholar 

  48. Wong VA, Marshall JA, Whitehead KJ, Williamson RM, Sullivan TJ. Management of periocular basal cell carcinoma with modified en face frozen section controlled excision. Ophthal Plast Reconstr Surg. 2002; 18:430–5.

    Article  PubMed  Google Scholar 

  49. Dzubow LM. Sebaceous carcinoma of the eyelid: treatment with Mohs surgery. J Dermatol Surg Oncol. 1985;11:40–4.

    PubMed  CAS  Google Scholar 

  50. Ratz JL, Luu-Duong S, Kulwin DR. Sebaceous carcinoma of the eyelid treated with Mohs’ surgery. J Am Acad Dermatol. 1986;14:668–73.

    Article  PubMed  CAS  Google Scholar 

  51. Yount AB, Bylund D, Pratt SG, Greenway HT. Mohs micrographic excision of sebaceous carcinoma of the eyelids. J Dermatol Surg Oncol. 1994;20:523–9.

    PubMed  CAS  Google Scholar 

  52. Spencer JM, Nossa R, Tse DT, Sequeira M. Sebaceous carcinoma of the eyelid treated with Mohs micrographic surgery. J Am Acad Dermatol. 2001;44:1004–9.

    Article  PubMed  CAS  Google Scholar 

  53. Callahan EF, Appert DL, Roenigk RK, Bartley GB. Sebaceous carcinoma of the eyelid: a review of 14 cases. Dermatol Surg. 2004;30:1164–8.

    Article  PubMed  Google Scholar 

  54. Snow SN, Larson PO, Lucarelli MJ, Lemke BN, Madjar DD. Sebaceous carcinoma of the eyelids treated by mohs micrographic surgery: report of nine cases with review of the literature. Dermatol Surg. 2002;28:623–31.

    Article  PubMed  Google Scholar 

  55. Berlin AL, Amin SP, Goldberg DJ. Extraocular sebaceous carcinoma treated with Mohs micrographic surgery: report of a case and review of literature. Dermatol Surg. 2008;34:254–7.

    Article  PubMed  CAS  Google Scholar 

  56. Reina RS, Parry E. Aggressive extraocular sebaceous carcinoma in a 52-year-old man. Dermatol Surg. 2006;32:1283–6.

    Article  PubMed  CAS  Google Scholar 

  57. Baker SR, Krause CJ. Carcinoma of the lip. Laryngoscope. 1980;90:19–27.

    Article  PubMed  CAS  Google Scholar 

  58. Holmkvist KA, Roenigk RK. Squamous cell carcinoma of the lip treated with Mohs micrographic surgery: outcome at 5 years. J Am Acad Dermatol. 1998;38:960–6.

    Article  PubMed  CAS  Google Scholar 

  59. Mohs F, Larson P, Iriondo M. Micrographic surgery for the microscopically controlled excision of carcinoma of the external ear. J Am Acad Dermatol. 1988;19:729–37.

    Article  PubMed  CAS  Google Scholar 

  60. Mohs FE. Chemosurgical treatment of melanoma; a microscopically controlled method of excision. Arch Derm Syphilol. 1950;62:269–79.

    PubMed  CAS  Google Scholar 

  61. Barlow RJ, White CR, Swanson NA. Mohs’ micrographic surgery using frozen sections alone may be unsuitable for detecting single atypical melanocytes at the margins of melanoma in situ. Br J Dermatol. 2002;146:290–4.

    Article  PubMed  CAS  Google Scholar 

  62. Nield DV, Saad MN, Khoo CT, Lott M, Ali MH. Tumour thickness in malignant melanoma: the limitations of frozen section. Br J Plast Surg. 1988;41: 403–7.

    Article  PubMed  CAS  Google Scholar 

  63. Shafir R, Hiss J, Tsur H, Bubis JJ. Pitfalls in frozen section diagnosis of malignant melanoma. Cancer. 1983;51:1168–70.

    Article  PubMed  CAS  Google Scholar 

  64. Zitelli JA, Moy RL, Abell E. The reliability of frozen sections in the evaluation of surgical margins for ­melanoma. J Am Acad Dermatol. 1991;24:102–6.

    Article  PubMed  CAS  Google Scholar 

  65. Zitelli JA, Brown CD, Hanusa BH. Surgical margins for excision of primary cutaneous melanoma. J Am Acad Dermatol. 1997;37:422–9.

    Article  PubMed  CAS  Google Scholar 

  66. Zitelli JA, Brown C, Hanusa BH. Mohs micrographic surgery for the treatment of primary cutaneous melanoma. J Am Acad Dermatol. 1997;37: 236–45.

    Article  PubMed  CAS  Google Scholar 

  67. Pitman GH, Kopf AW, Bart RS, Casson PR. Treatment of lentigo maligna and lentigo maligna melanoma. J Dermatol Surg Oncol. 1979 Sep;5(9):727–37.

    Article  PubMed  CAS  Google Scholar 

  68. Bienert TN, Trotter MJ, Arlette JP. Treatment of cutaneous melanoma of the face by Mohs micrographic surgery. J Cutan Med Surg. 2003;7:25–30.

    Article  PubMed  Google Scholar 

  69. Bene NI, Healy C, Coldiron BM. Mohs micrographic surgery is accurate 95.1% of the time for melanoma in situ: a prospective study of 167 cases. Dermatol Surg. 2008;34:660–4.

    Article  PubMed  CAS  Google Scholar 

  70. Dhawan SS, Wolf DJ, Rabinovitz HS, Poulos E. Lentigo maligna. The use of rush permanent sections in therapy. Arch Dermatol. 1990;126:928–30.

    Article  PubMed  CAS  Google Scholar 

  71. Stonecipher MR, Leshin B, Patrick J, White WL. Management of lentigo maligna and lentigo maligna melanoma with paraffin-embedded tangential sections: utility of immunoperoxidase staining and supplemental vertical sections. J Am Acad Dermatol. 1993;29:589–94.

    Article  PubMed  CAS  Google Scholar 

  72. Cohen LM, McCall MW, Hodge SJ, Freedman JD, Callen JP, Zax RH. Successful treatment of lentigo maligna and lentigo maligna melanoma with Mohs’ micrographic surgery aided by rush permanent sections. Cancer. 1994;73:2964–70.

    Article  PubMed  CAS  Google Scholar 

  73. Cohen LM, McCall MW, Zax RH. Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma. A follow-up study. Dermatol Surg. 1998;24:673–7.

    Article  PubMed  CAS  Google Scholar 

  74. Albertini JG, Elston DM, Libow LF, Smith SB, Farley MF. Mohs micrographic surgery for melanoma: a case series, a comparative study of immunostains, an informative case report, and a unique mapping technique. Dermatol Surg. 2002;28:656–65.

    Article  PubMed  Google Scholar 

  75. Zalla MJ, Lim KK, Dicaudo DJ, Gagnot MM. Mohs micrographic excision of melanoma using immunostains. Dermatol Surg. 2000;26:771–84.

    Article  PubMed  CAS  Google Scholar 

  76. Kelley LC, Starkus L. Immunohistochemical staining of lentigo maligna during Mohs micrographic surgery using MART-1. J Am Acad Dermatol. 2002;46: 78–84.

    Article  PubMed  Google Scholar 

  77. Mallipeddi R, Stark J, Xie XJ, Matthews M, Taylor RS. A novel 2-hour method for rapid preparation of permanent paraffin sections when treating melanoma in situ with mohs micrographic surgery. Dermatol Surg. 2008;34:1520–6.

    Article  PubMed  CAS  Google Scholar 

  78. Diagnosis and Treatment of Early Melanoma. National Institutes of Health Consensus Development Conference Statement on diagnosis and treatment of early melanoma, January 27–29, 1992. Am J Dermatopathol. 1993;15:34–43; discussion 6–51.

    Google Scholar 

  79. NCCN clinical practice guidelines in oncology: melanoma [monograph on the Internet]. Jenkintown: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/PDF/melanoma.pdf. Accessed 1 March 2006.

  80. Sober AJ, Chuang TY, Duvic M, Farmer ER, Grichnik JM, Halpern AC, et al. Guidelines of care for primary cutaneous melanoma. J Am Acad Dermatol. 2001;45: 579–86.

    Article  PubMed  CAS  Google Scholar 

  81. Megahed M, Schon M, Selimovic D, Schon MP. Reliability of diagnosis of melanoma in situ. Lancet. 2002;359:1921–2.

    Article  PubMed  Google Scholar 

  82. Bricca GM, Brodland DG, Ren D, Zitelli JA. Cutaneous head and neck melanoma treated with Mohs micrographic surgery. J Am Acad Dermatol. 2005;52:92–100.

    Article  PubMed  Google Scholar 

  83. Bhardwaj SS, Tope WD, Lee PK. Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma using Mel-5 immunostaining: University of Minnesota experience. Dermatol Surg. 2006;32:690–6; discussion 6–7.

    Google Scholar 

  84. Temple CL, Arlette JP. Mohs micrographic surgery in the treatment of lentigo maligna and melanoma. J Surg Oncol. 2006;94:287–92.

    Article  PubMed  Google Scholar 

  85. Mohs F. Chemosurgery in cancer, gangrene, and infections. Springfield: Charles C. Thomas; 1956.

    Google Scholar 

  86. Mohs FE. Chemosurgery for melanoma. Arch Dermatol. 1977;113:285–91.

    Article  PubMed  CAS  Google Scholar 

  87. Zitelli JA, Mohs FE, Larson P, Snow S. Mohs micrographic surgery for melanoma. Dermatol Clin. 1989;7:833–43.

    PubMed  CAS  Google Scholar 

  88. Haag ML, Glass LF, Fenske NA. Merkel cell carcinoma. Diagnosis and treatment. Dermatol Surg. 1995;21:669–83.

    Article  PubMed  CAS  Google Scholar 

  89. Suarez C, Rodrigo JP, Ferlito A, Devaney KO, Rinaldo A. Merkel cell carcinoma of the head and neck. Oral Oncol. 2004;40:773–9.

    Article  PubMed  Google Scholar 

  90. Allen PJ, Zhang ZF, Coit DG. Surgical management of Merkel cell carcinoma. Ann Surg. 1999;229:97–105.

    Article  PubMed  CAS  Google Scholar 

  91. Boyer JD, Zitelli JA, Brodland DG, D’Angelo G. Local control of primary Merkel cell carcinoma: review of 45 cases treated with Mohs micrographic surgery with and without adjuvant radiation. J Am Acad Dermatol. 2002;47:885–92.

    Article  PubMed  Google Scholar 

  92. O’Connor WJ, Roenigk RK, Brodland DG. Merkel cell carcinoma. Comparison of Mohs micrographic surgery and wide excision in eighty-six patients. Dermatol Surg. 1997;23:929–33.

    Article  PubMed  Google Scholar 

  93. Snow SN, Larson PO, Hardy S, Bentz M, Madjar D, Landeck A, et al. Merkel cell carcinoma of the skin and mucosa: report of 12 cutaneous cases with 2 cases arising from the nasal mucosa. Dermatol Surg. 2001;27:165–70.

    Article  PubMed  CAS  Google Scholar 

  94. Dancey AL, Rayatt SS, Soon C, Ilchshyn A, Brown I, Srivastava S. Merkel cell carcinoma: a report of 34 cases and literature review. J Plast Reconstr Aesthet Surg. 2006;59:1294–9.

    Article  PubMed  CAS  Google Scholar 

  95. Taylor HB, Helwig EB. Dermatofibrosarcoma protuberans. A study of 115 cases. Cancer. 1962;15: 717–25.

    Article  PubMed  CAS  Google Scholar 

  96. Dawes KW, Hanke CW. Dermatofibrosarcoma protuberans treated with Mohs micrographic surgery: cure rates and surgical margins. Dermatol Surg. 1996;22:530–4.

    Article  PubMed  CAS  Google Scholar 

  97. Ratner D, Thomas CO, Johnson TM, Sondak VK, Hamilton TA, Nelson BR, et al. Mohs micrographic surgery for the treatment of dermatofibrosarcoma ­protuberans. Results of a multiinstitutional series with an analysis of the extent of microscopic spread. J Am Acad Dermatol. 1997;37:600–13.

    Article  PubMed  CAS  Google Scholar 

  98. Robinson JK. Dermatofibrosarcoma protuberans resected by Mohs’ surgery (chemosurgery). A 5-year prospective study. J Am Acad Dermatol. 1985;12: 1093–8.

    Article  PubMed  CAS  Google Scholar 

  99. Hafner J, Schutz K, Morgenthaler W, Steiger E, Meyer V, Burg G. Micrographic surgery (“slow Mohs”) in cutaneous sarcomas. Dermatology. 1999; 198:37–43.

    Article  PubMed  CAS  Google Scholar 

  100. Thomas CJ, Wood GC, Marks VJ. Mohs micrographic surgery in the treatment of rare aggressive cutaneous tumors: the Geisinger experience. Dermatol Surg. 2007;33:333–9.

    Article  PubMed  CAS  Google Scholar 

  101. Garcia C, Clark RE, Buchanan M. Dermatofib­rosarcoma protuberans. Int J Dermatol. 1996;35: 867–71.

    Article  PubMed  CAS  Google Scholar 

  102. Snow SN, Gordon EM, Larson PO, Bagheri MM, Bentz ML, Sable DB. Dermatofibrosarcoma protuberans: a report on 29 patients treated by Mohs micrographic surgery with long-term follow-up and review of the literature. Cancer. 2004;101:28–38.

    Article  PubMed  Google Scholar 

  103. Nouri K, Lodha R, Jimenez G, Robins P. Mohs micrographic surgery for dermatofibrosarcoma protuberans: University of Miami and NYU experience. Dermatol Surg. 2002;28:1060–4; discussion 4.

    Google Scholar 

  104. Gloster Jr HM, Harris KR, Roenigk RK. A comparison between Mohs micrographic surgery and wide surgical excision for the treatment of dermatofibrosarcoma protuberans. J Am Acad Dermatol. 1996;35:82–7.

    Article  PubMed  Google Scholar 

  105. Haycox CL, Odland PB, Olbricht SM, Casey B. Dermatofibrosarcoma protuberans (DFSP): growth characteristics based on tumor modeling and a review of cases treated with Mohs micrographic surgery. Ann Plast Surg. 1997;38:246–51.

    Article  PubMed  CAS  Google Scholar 

  106. Paradisi A, Abeni D, Rusciani A, Cigna E, Wolter M, Scuderi N, et al. Dermatofibrosarcoma protuberans: wide local excision vs. Mohs micrographic surgery. Cancer Treat Rev. 2008;34:728–36.

    Article  PubMed  CAS  Google Scholar 

  107. Nelson RA, Arlette JP. Mohs micrographic surgery and dermatofibrosarcoma protuberans: a multidisciplinary approach in 44 patients. Ann Plast Surg. 2008;60:667–72.

    Article  PubMed  CAS  Google Scholar 

  108. Hobbs ER, Wheeland RG, Bailin PL, Ratz JL, Yetman RJ, Zins JE. Treatment of dermatofibrosarcoma protuberans with Mohs micrographic surgery. Ann Surg. 1988;207:102–7.

    Article  PubMed  CAS  Google Scholar 

  109. Wright TI, Petersen JE. Treatment of recurrent dermatofibrosarcoma protuberans with imatinib mesylate, followed by Mohs micrographic surgery. Dermatol Surg. 2007;33:741–4.

    Article  PubMed  CAS  Google Scholar 

  110. McArthur GA, Demetri GD, van Oosterom A, Heinrich MC, Debiec-Rychter M, Corless CL, et al. Molecular and clinical analysis of locally advanced dermatofibrosarcoma protuberans treated with imatinib: imatinib Target Exploration Consortium Study B2225. J Clin Oncol. 2005;23:866–73.

    Article  PubMed  CAS  Google Scholar 

  111. Ortiz AE, Wu JJ, Linden KG. Letter: clear margins after the use of imatinib mesylate prior to resection of extensive dermatofibrosarcoma protuberans. Dermatol Surg. 2008;34:1151.

    Article  PubMed  CAS  Google Scholar 

  112. Davis JL, Randle HW, Zalla MJ, Roenigk RK, Brodland DG. A comparison of Mohs micrographic surgery and wide excision for the treatment of atypical fibroxanthoma. Dermatol Surg. 1997;23:105–10.

    Article  PubMed  Google Scholar 

  113. Seavolt M, McCall M. Atypical fibroxanthoma: review of the literature and summary of 13 patients treated with mohs micrographic surgery. Dermatol Surg. 2006;32:435–41; discussion 9–41.

    Google Scholar 

  114. Huether MJ, Zitelli JA, Brodland DG. Mohs micrographic surgery for the treatment of spindle cell tumors of the skin. J Am Acad Dermatol. 2001;44: 656–9.

    Article  PubMed  CAS  Google Scholar 

  115. Brown MD, Swanson NA. Treatment of malignant fibrous histiocytoma and atypical fibrous xanthomas with micrographic surgery. J Dermatol Surg Oncol. 1989;15:1287–92.

    PubMed  CAS  Google Scholar 

  116. Limmer BL, Clark DP. Cutaneous micrographic ­surgery for atypical fibroxanthoma. Dermatol Surg. 1997;23:553–7; discussion 7–8.

    Google Scholar 

  117. Leibovitch I, Huilgol SC, Richards S, Paver R, Selva D. Scalp tumors treated with Mohs micrographic surgery: clinical features and surgical outcome. Dermatol Surg. 2006;32:1369–74.

    Article  PubMed  CAS  Google Scholar 

  118. Dzubow LM. Mohs surgery report: spindle cell fibrohistiocytic tumors: classification and pathophysiology. J Dermatol Surg Oncol. 1988;14:490–5.

    PubMed  CAS  Google Scholar 

  119. Chilukuri S, Alam M, Goldberg LH. Two atypical fibroxanthomas of the ear. Dermatol Surg. 2003 Apr;29(4):408–10.

    PubMed  CAS  Google Scholar 

  120. Hakim I. Atypical fibroxanthoma. Ann Otol Rhinol Laryngol. 2001;110:985–7.

    PubMed  CAS  Google Scholar 

  121. Fretzin DF, Helwig EB. Atypical fibroxanthoma of the skin. A clinicopathologic study of 140 cases. Cancer. 1973;31:1541–52.

    Article  PubMed  CAS  Google Scholar 

  122. Brown MD. Recognition and management of unusual cutaneous tumors. Dermatol Clin. 2000;18: 543–52.

    Article  PubMed  CAS  Google Scholar 

  123. Zalla MJ, Randle HW, Brodland DG, Davis JL, Roenigk RK. Mohs surgery vs wide excision for atypical fibroxanthoma: follow-up. Dermatol Surg. 1997;23:1223–4.

    PubMed  CAS  Google Scholar 

  124. Hausner RJ, Vargas-Cortes F, Alexander RW. Dermatofibrosarcoma protuberans with lymph node involvement. A case report of simultaneous occurrence with an atypical fibroxanthoma of the skin. Arch Dermatol. 1978;114:88–91.

    Article  PubMed  CAS  Google Scholar 

  125. Burns MK, Chen SP, Goldberg LH. Microcystic adnexal carcinoma. Ten cases treated by Mohs micrographic surgery. J Dermatol Surg Oncol. 1994; 20:429–34.

    PubMed  CAS  Google Scholar 

  126. Friedman PM, Friedman RH, Jiang SB, Nouri K, Amonette R, Robins P. Microcystic adnexal carcinoma: collaborative series review and update. J Am Acad Dermatol. 1999;41:225–31.

    Article  PubMed  CAS  Google Scholar 

  127. Chiller K, Passaro D, Scheuller M, Singer M, McCalmont T, Grekin RC. Microcystic adnexal carcinoma: forty-eight cases, their treatment, and their outcome. Arch Dermatol. 2000;136:1355–9.

    Article  PubMed  CAS  Google Scholar 

  128. Snow S, Madjar DD, Hardy S, Bentz M, Lucarelli MJ, Bechard R, et al. Microcystic adnexal carcinoma: report of 13 cases and review of the literature. Dermatol Surg. 2001;27:401–8.

    Article  PubMed  CAS  Google Scholar 

  129. Leibovitch I, Huilgol SC, Selva D, Lun K, Richards S, Paver R. Microcystic adnexal carcinoma: treatment with Mohs micrographic surgery. J Am Acad Dermatol. 2005;52:295–300.

    Article  PubMed  Google Scholar 

  130. Abbate M, Zeitouni NC, Seyler M, Hicks W, Loree T, Cheney RT. Clinical course, risk factors, and ­treatment of microcystic adnexal carcinoma: a short series report. Dermatol Surg. 2003;29:1035–8.

    Article  PubMed  Google Scholar 

  131. Goldberg DJ, Kim YA. Angiosarcoma of the scalp treated with Mohs micrographic surgery. J Dermatol Surg Oncol. 1993;19:156–8.

    PubMed  CAS  Google Scholar 

  132. Muscarella VA. Angiosarcoma treated by Mohs micrographic surgery. J Dermatol Surg Oncol. 1993;19:1132–3.

    PubMed  CAS  Google Scholar 

  133. Thissen MR, Neumann MH, Schouten LJ. A systematic review of treatment modalities for primary basal cell carcinomas. Arch Dermatol. 1999;135: 1177–83.

    Article  PubMed  CAS  Google Scholar 

  134. Smeets NW, Krekels GA, Ostertag JU, Essers BA, Dirksen CD, Nieman FH, et al. Surgical excision vs Mohs’ micrographic surgery for basal-cell carcinoma of the face: randomised controlled trial. Lancet. 2004;364:1766–72.

    Article  PubMed  Google Scholar 

  135. Mosterd K, Krekels GA, Nieman FH, Ostertag JU, Essers BA, Dirksen CD, 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;9:1149–56.

    Article  PubMed  Google Scholar 

  136. Rowe DE, Carroll RJ, Day Jr CL. Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma. J Dermatol Surg Oncol. 1989;15:424–31.

    PubMed  CAS  Google Scholar 

  137. Cook J, Zitelli JA. Mohs micrographic surgery: a cost analysis. J Am Acad Dermatol. 1998;39:698–703.

    Article  PubMed  CAS  Google Scholar 

  138. Lear W, Mittmann N, Barnes E, Breen D, Murray C. Cost comparisons of managing complex facial basal cell carcinoma: Canadian study. J Cutan Med Surg. 2008;12:82–7.

    PubMed  Google Scholar 

  139. Parker TL, Zitelli JA. Surgical margins for excision of dermatofibrosarcoma protuberans. J Am Acad Dermatol. 1995;32(2 Pt 1):233–6.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Dermatology, Department of Medicine, Vanderbilt University, One Hundred Oaks, 719 Thompson Lane, Suite 26300, Nashville, TN, 37204, USA

    Alan L. Levy & Thomas Stasko

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  1. Alan L. Levy
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  2. Thomas Stasko
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Correspondence to Thomas Stasko .

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  1. Aesthetic Surgery, Professor, Departments of Dermatology,, Chief, Section of Cutaneous and, Feinberg School of Med, Northwestern Univ, Chicago, 60611, Illinois, USA

    Murad Alam

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Levy, A.L., Stasko, T. (2012). Mohs Surgery. In: Alam, M. (eds) Evidence-Based Procedural Dermatology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-09424-3_1

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