Mohs micrographic surgery has been performed by dermatologists for 70 years, becoming especially popular in the last 40 years. Mohs surgery was first used for nonmelanoma skin cancers, but today dermatologists use it for various other skin cancers, including melanoma. A survey lead by American Mohs surgeons stated that, “98% of the tumors found and treated by Mohs surgery were nonmelanoma skin cancers. 73% were Basal Cell Carcinomas and 23% were Squamous Cell Carcinomas.”
Mohs has become more common amongst dermatologist worldwide, especially when treating smaller Basal Cell Carcinomas (BCCs). As far as recurrence goes, lower rates have been gained by using Mohs surgery with BCCs. The article said, “In a recent study performed in Italy, the BCC recurrence rate after MMS (Mohs Micrographic Surgery) was 3.4% for primary BCC and 4.9% for recurrent BCC.” Almost 88% of the Basal Cell Carcinomas treated, needed a minimum of two stages of Mohs surgery to extinguish the skin cancers. In a study performed in Spain, the recurrence find was less than 1% after 32 months of continuous visits. Squamous Cell Carcinomas (SCCs) tend to be more aggressive than BCCs due to SCCs well known relationship with frequent sun exposure. Aggressive means nothing to Mohs, however, because it is performed on patients with primary and recurring Squamous Cell Carcinomas. The recurrence rates look even better being they are at a low 1.2%. Dermatologists have learned that ‘massive inflammatory infiltrates’ in SCCs can in fact hide tumors. With this knowledge, doctors began removing extra layers of skin in Mohs surgery for extra precaution when working with these infiltrates.
The author goes to say in his article that, “Based on my personal experience in MMS for almost 20 years, I prefer to define Mohs surgery in a rigid functional way: Peripheral margins must be cut at an angle of 45 degrees in most cases; frozen sections are by definition part of modern MMS; the frozen section laboratory must be adjacent to the operating room; and the surgeon should be the one who reads the slides.” He believes all values and guidelines of Mohs should be properly met when performing the procedure.