Mohs surgery for melanoma: rationale, advances and possibilities

Mohs surgery (MS) is an effective technique for the removal of a variety of cutaneous neoplasms by virtue of its thorough assessment of margins. It has yet to become widely accepted for melanoma because recognizing melanocytes histologically in frozen section can be problematic. Recently, 'rapid' methods of immunohistochemistry have been developed that resolve this issue by staining the melanocytes in frozen section. In addition, some of the immunohistochemistry protocols that previously required up to 1 h now take 19 min or less. These technological enhancements for MS have removed some of the obstacles towards the acceptance of MS as a legitimate option for removal of melanomas, especially poorly demarcated lesions and lesions from the head and neck, the distal extremities and the genitalia. Experience thus far with MS for melanoma has shown lower recurrence rates and improved disease-specific survival compared with historical controls for standard excision, while at the same time minimizing the sacrifice of normal tissue.