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

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].

2018 ◽  
Vol 23 (1) ◽  
pp. 75-90 ◽  
Author(s):  
Christian Murray ◽  
Duvaraga Sivajohanathan ◽  
Timothy P. Hanna ◽  
Scott Bradshaw ◽  
Nowell Solish ◽  
...  

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.


2012 ◽  
Vol 16 (6) ◽  
pp. 388-393 ◽  
Author(s):  
Lauren Laberge ◽  
Julie Lacroix ◽  
Adam J. Mamelak

Background: The Ministry of Health and Long-Term Care, in coordination with Cancer Care Ontario, records and analyzes wait times for cancer surgery in the province of Ontario. However, this strategy does not include wait times for skin cancer surgery. Purpose: The wait times and referral patterns of patients undergoing Mohs micrographic surgery at The Ottawa Hospital (TOH) were examined to better assess the adequacy of access to skin cancer treatment in Ontario. Method: The records of 101 Mohs surgeries (96 patients) consecutively performed at TOH between June 14, 2010, and October 19, 2010, were reviewed. The interval between the date the referral for Mohs surgery was first received and the date of surgery was calculated for each case. The specialty of the referring physician and the postal code of each patient treated were also recorded. Results: The average wait time between the date of referral and the date of surgery was 122.6 days or 17.5 weeks (median 124 days, 17.7 weeks). Over 75% of patients waited over 12 weeks (84 days) for cancer surgery. All Mohs surgery patients treated at TOH resided within postal districts in eastern and northern Ontario. Conclusion: The current wait time for Mohs surgery in the Ottawa region is beyond the standard for cancer treatment. Improving access to care and incorporating Mohs surgery into the Ministry of Health and Long-Term Care's Wait Time Strategy might significantly improve this. Renseignements de base: Le ministère de la Santé et des Soins de longue durée, en coordination avec Action Cancer Ontario, enregistre et analyse les délais d'attente pour les chirurgies du cancer dans la province de l'Ontario. Cependant, cette stratégie ne tient pas compte des délais d'attente pour les chirurgies du cancer de la peau. Objectif: Les délais d'attente et les modes d'aiguillage des patients subissant une chirurgie micrographique de Mohs à l'Hôpital d'Ottawa (L'HO) ont été examinés afin de mieux évaluer la pertinence de l'accès au traitement du cancer de la peau en Ontario. Méthode: Les dossiers de 101 cas de chirurgies de Mohs (96 patients) qui ont été effectuées consécutivement à L'HO du 14 juin 2010 au 19 octobre 19 2010 ont été examinés. L'intervalle entre la date à laquelle la recommandation de la chirurgie de Mohs a d'abord été reçue et la date de la chirurgie a été calculé pour chaque cas. La spécialité du médecin orienteur et le code postal de chaque patient traité ont également été enregistrés. Résultats: Le délai d'attente moyen entre la date de recommandation et la date de la chirurgie a été 122,6 jours, soit 17,5 semaines (médiane 124 jours, 17,7 semaines). Plus de 75% des patients ont attendu plus de 12 semaines (84 jours) pour une chirurgie du cancer. Tous les patients qui ont subi une chirurgie de Mohs à L'HO demeuraient dans les districts postaux dans l'est et le nord de l'Ontario. Conclusion: Le délai d'attente actuel pour la chirurgie de Mohs dans la région d'Ottawa est au-delà de la norme pour le traitement du cancer. L'amélioration de l'accès aux soins et l'intégration de la chirurgie de Mohs dans la Stratégie ontarienne de réduction des temps d'attente du ministère de la Santé et des Soins de longue durée pourraient considérablement améliorer cette situation.


Author(s):  
Maria Charalambides ◽  
Basil Yannoulias ◽  
Nabiah Malik ◽  
Jasmine Mann ◽  
Perin Celebi ◽  
...  

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