Patient Indications for Mohs Micrographic Surgery: A Systematic Review

2018 ◽  
Vol 23 (1) ◽  
pp. 75-90 ◽  
Author(s):  
Christian Murray ◽  
Duvaraga Sivajohanathan ◽  
Timothy P. Hanna ◽  
Scott Bradshaw ◽  
Nowell Solish ◽  
...  
Keyword(s):  
Skin Cancer ◽  
Retrospective Studies ◽  
Standard Of Care ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery ◽  
Skin Cancers ◽  
Cochrane Database ◽  
The Face ◽  
Aggressive Histology

The purpose of the present review was to describe evidence-based indications for Mohs micrographic surgery (MMS) in patients with a diagnosis of skin cancer. Relevant studies were identified from a systematic MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews search of studies published from 1970 to 2017. Randomized controlled trials (RCTs), prospective and retrospective comparative studies with greater than 30 patients, and single-arm retrospective studies with multivariate analyses were included. A total of 2 RCTs, 3 prospective studies, and 16 retrospective studies (14 comparative and 2 single-arm) were included. Data on recurrence rate, cure rate, complications, cosmesis, and quality of life were extracted. Surgery (with postoperative or intraoperative marginal assessment) or radiation for those who are ineligible for surgery should remain the standard of care for patients with skin cancer given the lack of high-quality, comparative evidence. MMS is recommended for those with histologically confirmed recurrent basal cell carcinoma (BCC) of the face and is appropriate for primary BCCs of the face that are >1 cm, have aggressive histology, or are located on the H zone of the face. The available evidence is difficult to generalize to all patients with skin cancer because the evidence did not adequately cover non-BCC skin cancers; however, those skin cancers can be considered on a case-by-case basis for MMS. MMS should be performed by physicians who have completed a degree in medicine or equivalent, including a Royal College of Physicians and Surgeons of Canada Specialist Certificate or equivalent, and have received advanced training in MMS.

scholarly journals Patient indications for Mohs micrographic surgery: a clinical practice guideline

2019 ◽  
Vol 26 (1) ◽  
Author(s):  
C. Murray ◽  
D. Sivajohanathan ◽  
T. P. Hanna ◽  
S. Bradshaw ◽  
N. Solish ◽  
...  
Keyword(s):  
Basal Cell ◽  
Relevant Literature ◽  
Standard Of Care ◽  
Surgical Oncology ◽  
Evidence Based ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery ◽  
Disease Site ◽  
The Face ◽  
Evidence Based Care

Objective The purpose of the present work was to develop evidence-based indications for Mohs micrographic surgery in patients with a diagnosis of skin cancer.Methods The guideline was developed by Cancer Care Ontario’s Program in Evidence-Based Care, together with the Melanoma Disease Site Group and the Surgical Oncology Program, through a systematic review of relevant literature, patient- and caregiver-specific consultation, and internal and external reviews.Recommendation 1 Given a lack of high-quality, comparative evidence, surgery (with postoperative or intraoperative margin assessment) or radiation (for those who are ineligible for surgery) should remain the standard of care for patients with skin cancer.Recommendation 2 Mohs micrographic surgery is recommended for patients with histologically confirmed recurrent basal cell carcinoma of the face and is appropriate for primary basal cell carcinomas of the face that are larger than 1 cm, have aggressive histology, or are located on the H zone of the face.Recommendation 3 Mohs micrographic surgery should be performed by physicians who have completed a degree in medicine or equivalent, including a Royal College of Physicians and Surgeons of Canada Specialist Certificate or equivalent, and have received advanced training in Mohs micrographic surgery.

scholarly journals Mohs Micrographic Surgery Sine Microscopy: Is mass spectrometry an upcoming intraoperative cancer margin assessment tool?

2019 ◽  
pp. 1-3
Author(s):  
Lawrence Siu-Yung Chan
Keyword(s):  
Skin Cancer ◽  
Zinc Chloride ◽  
Assessment Tool ◽  
Special Kind ◽  
Skin Layer ◽  
Layer By Layer ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery ◽  
Mohs Surgery ◽  
Skin Cancers

A special kind of skin cancer surgery, named Mohs micrographic surgery (or Mohs surgery), was invented by a University of Wisconsin Otolaryngologist, Dr. Frederick Mohs [1]. The initial Mohs surgery procedure, also called chemosurgery, employed a zinc chloride-containing chemical paste to destroy cancerous tissue layer by layer under microscopic control [1]. The procedure was subsequently modified to the current and well-accepted form, where patients affected by non-melanoma skin cancers of certain facial locations, recurrent skin cancers, or skin cancers with certain aggressive histologic features would be treated by a layered excisional procedure without the pain associated with zinc chloride paste [2]. The current procedure, with the ability to determine cancer margin in an intraoperative fashion, utilizes microscopic examinations of stained frozen sections obtained from an excised layer of orientation-marked skin where the clinical cancer is visually observed, while the patient waits for the result. Microscopic identification of cancer at the margin of excised skin layer will necessitate the return of the patient to the surgical table for addition layer of excision [3]. The process repeats if needed, until all margins are clear of skin cancer, at which point the Mohs surgeon will close the wound defect, commonly utilizing adjacent tissue transfer technique called flap [4].

A review of Mohs Micrographic Surgery for skin cancer: Part 1 ‐ melanoma and rare skin cancers

2021 ◽  
Author(s):  
Maria Charalambides ◽  
Basil Yannoulias ◽  
Nabiah Malik ◽  
Jasmine Mann ◽  
Perin Celebi ◽  
...  
Keyword(s):  
Skin Cancer ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery ◽  
Skin Cancers

scholarly journals Detailed head localization and incidence of skin cancers

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Marta Fijałkowska ◽  
Mateusz Koziej ◽  
Bogusław Antoszewski
Keyword(s):  
Skin Cancer ◽  
Cell Carcinoma ◽  
Vertical Dimension ◽  
Surgical Department ◽  
Surface Areas ◽  
Common Cancer ◽  
Skin Cancers ◽  
Sex Type ◽  
Cancer Subtype ◽  
The Face

AbstractSkin cancers are the most common neoplasms; frequently, they localize on the face. The aim of paper is to present the incidence of skin tumors in a single center from 2017 to 2019, describe trends in its frequency and find relations between neoplasms and sex, type of cancer, and its size. An analysis of histopathological files from the surgical department between 2017 and 2019 was calculated. These items were selected: sex, age, type of skin cancer, subtype of basal cell carcinoma (BCC), grading of squamous cell carcinoma (SCC), localization and dimensions of the tumor. The study sample consisted of 387 cases. BCC was the most common cancer and its nodular type was the most frequent. In older patients, the vertical dimension of excised carcinoma was significantly larger. Moreover, this connection was detected only in women compared to men. There were statistically significant differences between dimensions of the skin cancer and sex. In men group, skin cancers had statistically higher vertical dimensions and larger surface areas. On the face and head, BCC more often localizes in the nasal area, while SCC on the auricle. It has been demonstrated that the older the patient, the larger the vertical dimension of the tumor. As such, tumor size is larger in men than in women, as women usually see their physicians sooner than men: cosmetic concerns are more important to them.

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