Mohs Micrographic Surgery Management of Melanoma and Melanoma In Situ

Excerpt

Mohs micrographic surgery (MMS) is a precise, tissue-sparing procedure used to remove skin malignancies such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Although MMS is predominantly used for BCC and SCC, it has shown promise as a treatment for melanoma in situ (MIS) and invasive melanoma, with the potential for superior outcomes in disease management and aesthetic preservation.

This surgical method, named after its pioneer, Dr Frederic Mohs, enables precise microscopic control of the entire tumor edge while maximizing the preservation of normal tissue, which makes it especially useful for skin malignancies with a high risk of incomplete excision, recurrence, or risk of significant local tissue loss. Initially dubbed "chemosurgery," the treatment originally required the application of a chemical fixative (eg, zinc chloride) to the in vivo tumor, which was subsequently removed and examined microscopically. The technique has evolved to involve processing fresh tissue, then freezing and sectioning it in a cryostat microtome, permitting faster processing, reduced patient discomfort, and increased tissue conservation.

MMS enables microscopic control of the deep and peripheral tumor margins while conserving normal tissue, which makes it particularly useful for skin cancers with a high risk of incomplete excision or recurrence and when tissue conservation is crucial. MMS has shown promise in the treatment of melanoma, as indicated by numerous studies. The complete microscopic margin evaluation associated with MMS makes it an appropriate option for managing MIS and invasive melanoma, given their propensity for subclinical spread; MMS is also linked with superior outcomes in tumor extirpation and cosmesis.