Abstract
Mohs Micrographic Surgery (MMS) is the current gold standard for surgically excising complex skin cancers in anatomically sensitive locations under comprehensive frozen section margin control. The history of Mohs surgery dates back to the 1930s. At the time, skin cancer treatment lacked formal guidelines for surgical margins, and the method for removal was not consistent nor refined. Dr. Frederic Mohs, a research assistant in the Department of Zoology at the University of Wisconsin, originally worked alongside Professor Michael F. Guyer in his lab studying intralesional tumor injections. Dr. Mohs’s serendipitous finding, that Zinc Chloride paste fixes tissue with preservation of histologic features, paved the way for the eventual use of the paste in vivo, with subsequent removal of the treated cancerous tissue and histologic evaluation of the resected margin, a novel idea at the time. Horizontal sectioning with precise tissue mapping was an innovative way to remove skin cancers, allowing more targeted removal and margin assessment. Due to the application of Zinc Chloride paste, MMS was initially called “chemosurgery”. As the technique has evolved with time, so has the histologic processing, which distinguishes MMS from other skin cancer surgical approaches.
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Bibliography
Bobotsis R, Guenther L. How Mohs surgery transformed into a first-line treatment of skin cancer. J Cutan Med Surg. 2017;21(1):40–1. https://doi.org/10.1177/1203475416658289.
Brodland DG, Amonette R, Hanke CW, Robins P. The history and evolution of mohs micrographic surgery. Dermatol Surg. 2000;26(4):303–7. https://doi.org/10.1046/j.1524-4725.2000.00504.x.
Cameron MC, Lee E, Hibler BP, Barker CA, Mori S, Cordova M, et al. Basal cell carcinoma: epidemiology; pathophysiology; clinical and histological subtypes; and disease associations. J Am Acad Dermatol. 2019a;80(2):303–17. https://doi.org/10.1016/j.jaad.2018.03.060.
Cameron MC, Lee E, Hibler BP, Giordano CN, Barker CA, Mori S, et al. Basal cell carcinoma: contemporary approaches to diagnosis, treatment, and prevention. J Am Acad Dermatol. 2019b;80(2):321–39. https://doi.org/10.1016/j.jaad.2018.02.083.
Candiani JO. To Dr. Frederick Mohs, whom i would have liked to meet. Dermatol Surg. 2003;29(4):440. https://doi.org/10.1046/j.1524-4725.2003.29104.x
Connolly KL, Nehal KS, Disa JJ. Evidence-based medicine: cutaneous facial malignancies: nonmelanoma skin cancer: cutaneous facial malignancies. Plast Reconstr Surg. 2017;139(1):181e-e190. https://doi.org/10.1097/prs.0000000000002853.
Daniel C, Morris E, Curcio NM. The margin of victory for 50 years. American College of Mohs Surgery. 2018.
DePaolo C. Frederic E. Mohs, MD, and the History of Zinc Chloride. Clin Dermatol. 2018;36(4):568–75. https://doi.org/10.1016/j.clindermatol.2017.12.001
Dietert JB, MacFarlane DF. A survey of Mohs tissue tracking practices. Dermatol Surg. 2019;45(4):514–8. https://doi.org/10.1097/dss.0000000000001723.
Frederic Mohs tribute. Letters: in memoriam. J Drugs Dermatol. 2002;1(2):175–84.
Hanke CW. Frederic Mohs tribute. History of Mohs micrographic surgery. J Drugs Dermatol. 2002;1(2):169–74
Ip KH-K, Chan BCY. How we do it: color-coded patient labels for enhanced surgical instrument identification during Mohs micrographic surgery: color-coded patient labels for enhanced surgical instrument identification during mohs micrographic surgery. Dermatol Surg. 2021;47(8):1122–3. https://doi.org/10.1097/dss.0000000000003028
Kovach R, Welton WA, Wetmore SJ. Mohs micrographic surgery. W V Med J. 1990;86(12):551–5.
Ladda MA, Lynde CW. Mohs micrographic surgery: development of the technique. J Cutan Med Surg. 2019;23(2):236–236. https://doi.org/10.1177/1203475418811346.
Levy RM, Hanke CW. Mohs micrographic surgery: facts and controversies. Clin Dermatol. 2010;28(3):269–74. https://doi.org/10.1016/j.clindermatol.2009.06.014.
Nehal K, Lee E. Mohs surgery. 2023. Uptodate.com. https://www.uptodate.com/contents/mohs-surgery. Accessed 18 Jul 2023
Nehal KS, Bichakjian CK. Update on keratinocyte carcinomas. N Engl J Med. 2018;379(4):363–74. https://doi.org/10.1056/NEJMra1708701.
Papac N, Collins L. The female pioneers in Mohs micrographic surgery. Int J Womens Dermatol. 2019;5(1):18–20. https://doi.org/10.1016/j.ijwd.2018.08.006.
Patel TN, Patel SB, Franca K, Chacon AH, Nouri K. Mohs micrographic surgery: history, technique, and advancements. Skinmed. 2014;12(5):289–92.
Robins P. 44 years in dermatologic surgery: a retrospective. J Drugs Dermatol. 2009;8(6):519–25.
Ross NA, Saedi N, Yeo CJ, Cowan S. Frederic E. Mohs, M.D. (1910–2002): physician and innovator. Am Surg. 2015;81(5):433–7. https://doi.org/10.1177/000313481508100520
Shriner DL, McCoy DK, Goldberg DJ, Wagner RF Jr. Mohs micrographic surgery. J Am Acad Dermatol. 1998;39(1):79–97. https://doi.org/10.1016/s0190-9622(98)70405-0.
Siscos SM, Neill BC, Seger EW, Hooton TA, Hocker TLH. The current state of Mohs surgery for the treatment of melanoma: a nationwide cross-sectional survey of Mohs surgeons. Dermatol Surg. 2020;46(10):1267–71. https://doi.org/10.1097/DSS.0000000000002645.
Sood A, Ayyaswami V, Prabhu AV, Benedek TG. Frederic Edward Mohs, MD—the Pioneer of Chemosurgery. JAMA Dermatol. 2017;153(6):522. https://doi.org/10.1001/jamadermatol.2017.0723.
Stone JL. Mohs micrographic surgery: a synopsis. Hawaii Med J. 1993;52(5):134–9.
Trost LB, Bailin PL. History of Mohs surgery. Dermatol Clin. 2011;29(2):135–9. https://doi.org/10.1016/j.det.2011.01.010.
Work Group, Invited Reviewers, Kim JYS, Kozlow JH, Mittal B, Moyer J, et al. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol. 2018;78(3):540–59. https://doi.org/10.1016/j.jaad.2017.10.006
Work Group, Invited Reviewers, Kim JYS, Kozlow JH, Mittal B, Moyer J, et al. Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol. 2018;78(3):560–78. https://doi.org/10.1016/j.jaad.2017.10.007
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Connolly, K., Chow, M., Afzalneia, R., McKay, C., Nehal, K.S. (2024). History of Mohs Micrographic Surgery. In: McKay, C., Nehal, K.S. (eds) Laboratory Manual for Mohs Micrographic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-52434-9_1
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