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Floaters in Mohs micrographic surgery.

Murad Alam¹, Anjali D Shah, Sana Ali

¹Department of Dermatology, Northwestern University, Chicago, Illinois; Department of Otolaryngology, Northwestern University, Chicago, Illinois; Department of Surgery, Northwestern University, Chicago, Illinois.

Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [Et Al.]

|July 2, 2013

Summary

This summary is machine-generated.

Floaters, dislodged tumor tissue in Mohs micrographic surgery (MMS), are common and can obscure frozen sections. While causes like basal cell carcinomas are understood, management strategies for floaters lack consensus.

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Area of Science:

Dermatologic Surgery
Pathology
Oncology

Background:

Floaters, or dislodged tumor tissue fragments, frequently complicate Mohs micrographic surgery (MMS) by obscuring frozen sections and hindering accurate interpretation.
Understanding the incidence and origins of floaters is crucial for optimizing MMS procedures and diagnostic accuracy.

Framework:

A virtual consensus conference utilizing a 60-item questionnaire established expert agreement on floater causes.
Subsequent interviews with randomly selected Mohs surgeons validated these findings, ensuring robust data for analysis.

Implementation:

Analysis of 170,404 MMS cases across 230 surgeon-years revealed a 1.8% floater rate per tumor and 0.70% per tissue block.
Key contributing factors identified include not wiping blades between cuts, especially when separating tissue subunits, and the presence of basal cell carcinomas, ulcerated tumors, or tissue from initial surgical stages.

Implications:

Floaters are a significant, non-rare complication in MMS, impacting margin assessment and potentially requiring additional tissue processing.
While expert consensus exists on identifying and preventing floaters, standardized management protocols remain underdeveloped, highlighting a need for further research and guideline development.