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Simultaneous intraoperative Mohs clearance and reconstruction for advanced cutaneous malignancies
Rahul Seth1, Peter C Revenaugh, Allison T Vidimos
1Head and Neck Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Background:
Improved control of cutaneous malignancies using Mohs micrographic pathologic clearance has been well established. However, surgical margin control of advanced and complex cutaneous tumors of the head and neck is commonly performed by far less reliable frozen section margin analysis.
Objective:
To describe a routine and ideal collaboration between dermatologic surgery and facial plastic surgery/head and neck surgery in which the Mohs micrographic method is used intraoperatively to achieve marginal clearance during resection and reconstruction.
Methods:
A single-institution retrospective analysis was performed of patients who underwent intraoperative Mohs micrographic surgery. Intraoperative margins (peripheral and deep) of tissue specimens were analyzed by the Mohs surgeon.
Results:
Twenty-six patients underwent large cutaneous tumor resection using intraoperative Mohs micrographic surgery. Most lesions were basal (48%) or squamous (34%) cell carcinoma. A mean (SD) of 2.1 (0.98) resection layers were required before negative margins were achieved.
Conclusions:
We demonstrate the intraoperative technique and utility of Mohs micrographic analysis via an efficient collaborative effort. Well established for accuracy greater than intraoperative frozen section margin analysis, intraoperative Mohs micrographic surgery provides an optimal method of intraoperative margin assessment of cutaneous malignancies.
Insights
Mohs micrographic surgery offers superior intraoperative margin assessment for head and neck cutaneous malignancies compared to frozen section analysis. This collaborative technique ensures precise tumor removal and optimal patient outcomes.
Area of Science:
- Dermatologic Surgery
- Head and Neck Surgery
- Oncology
Background:
- Mohs micrographic surgery is established for cutaneous malignancy control.
- Advanced head and neck tumors often rely on less reliable frozen section margin analysis.
Observation:
- A retrospective analysis evaluated intraoperative Mohs micrographic surgery for large cutaneous tumors.
- Tissue margins were analyzed by the Mohs surgeon during resection and reconstruction.
Findings:
- Twenty-six patients with basal and squamous cell carcinomas underwent Mohs surgery.
- An average of 2.1 resection layers were needed to achieve negative margins.
Implications:
- Mohs micrographic surgery provides accurate intraoperative margin assessment.
- Collaboration between surgical specialties enhances oncologic control.
- This technique is optimal for complex cutaneous malignancies.