Mohs surgery

Micrographic surgery to trace residual tumor using horizontal sectioning.

Increased use by 400% between 1995 and 2009.

Involves microscopic examination of layers of tissue using horizontal frozen sections with mapping the origin of all specimens in a cyclic fashion of biopsy, mapping and microscopic analysis until no malignancy is found.

Evaluates the bottom and sides of a tissue specimen assessing 100% of the tumor margin.

Technique that maximizes normal tissue conservation.

Approach is superior to conventional surgical excision in treatment of most common cutaneous malignancies.

The microscopic margin examination with horizontal sectioning is superior to standard pathological review which utilizes cross-sectioning or bread-loaf sectioning to process tissue specimens.

With standard pathological processing less than 1% of excised margin is visualized, resulting in a higher potential for unrecognized tumor involvement and, therefore, higher tumor recurrences for standard excision.

Gold standard for management of nonmelanoma skin cancers.

In contrast to standard excisional surgery the incision is typically at an angle of 30-45 degrees with the skin just outside the clinically identifiable tumor margins for improved processing.

The surgeon identifies tumor margins by visual exam, palpation and curettage.

Mohs surgery takes about three times as long as conventional excision, with a mean procedure length of time three hours versus one hour for conventional surgery.

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