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Mohs micrographic surgery Mohs micrographic surgery is an is an

approach to skin cancer removal that aims to achieve approach to skin cancer removal that aims to achieve the highest possible rates of cure and to minimize the the highest possible rates of cure and to minimize the size of the wound and consequent distortions at critical size of the wound and consequent distortions at critical

sites such as the eyes, ears, nose, and lipssites such as the eyes, ears, nose, and lips

micrographic surgery is a twomicrographic surgery is a two--step, samestep, same--day day procedure performed with local anestheticprocedure performed with local anesthetic. . It It involves removing the tumor in stages by involves removing the tumor in stages by histologically confirming clear margins on frozen histologically confirming clear margins on frozen sections and by addressing the resultant defectsections and by addressing the resultant defect. . Options for healing include second intent, primary Options for healing include second intent, primary closure, local flaps, interpolation flaps, and graftsclosure, local flaps, interpolation flaps, and grafts. . Larger tumors may require referral for Larger tumors may require referral for reconstructive surgeryreconstructive surgery. . Mohs micrographic Mohs micrographic surgery is the treatment of choice for skin tumors surgery is the treatment of choice for skin tumors in critical sites, large or recurrent tumors, tumors in critical sites, large or recurrent tumors, tumors in sites of radiation therapy, and tumors with in sites of radiation therapy, and tumors with aggressive histologic featuresaggressive histologic features. .

. . Mohs micrographic surgical techniqueMohs micrographic surgical technique. (. (AA) ) The The visible tumor is curetted visible tumor is curetted ((not shownnot shown) ) and then and then removed with a scalpelremoved with a scalpel. . By convention, the By convention, the cephalad orientation is labeled as the 12 o'clock cephalad orientation is labeled as the 12 o'clock positionposition. . Four stylized, severed tumor roots are Four stylized, severed tumor roots are illustrated here but would not be visible to the illustrated here but would not be visible to the naked eyenaked eye. (. (BB) ) The excised specimen is laid flat The excised specimen is laid flat and sliced in horizontal sections from the and sliced in horizontal sections from the undersurface toward the surfaceundersurface toward the surface. . The horizontal The horizontal sections indicate residual tumor at four focisections indicate residual tumor at four foci. (. (CC) ) The surgeon returns to the patient and removes The surgeon returns to the patient and removes sites with a second layer, as indicated by the sites with a second layer, as indicated by the purple incision linepurple incision line. .

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