Mohs micrographic surgery. Fresh-tissue technique

Because of its superior histologic control, when compared with conventional surgery, Mohs micrographic surgery offers 5-year cure rates of 98 to 99% when dealing with aggressive, extensive, and/or recurrent cutaneous neoplasms. Because the fresh-tissue technique is faster, less painful, and more tissue conserving, allows for immediate repairs, yields higher quality histologic preparations, and facilitates an interdisciplinary approach, it has become the preferred method of performing Mohs micrographic surgery. The fixed-tissue technique does offer certain advantages when dealing with (1) vascular neoplasms or tumors in vascular areas; (2) tumor in deep, narrow spaces; (3) tumor invading bone; or (4) tumors capable of implantation and metastatic spread. However, a modification of the fresh-tissue technique, the use of the CO2 laser, or an interdisciplinary approach may also allow the Mohs surgeon to effectively deal with these problem cases.