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Mohs Mapping Fidelity: Optimizing Orientation, Accuracy, and Tissue Identification in Mohs Surgery.

Janet Y Li1, Sirunya Silapunt1, Michael R Migden2

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Mohs micrographic surgery (MMS) accuracy relies on precise steps. This review identifies potential errors in MMS processes and offers protocols to improve accuracy and minimize false negatives.

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Area of Science:

  • Dermatology
  • Surgical Pathology

Background:

  • Mohs micrographic surgery (MMS) is a specialized technique for skin cancer removal.
  • Consistent accuracy in resection, mapping, and interpretation is crucial for MMS success.
  • Variations exist in MMS procedures among practitioners.

Purpose of the Study:

  • To review the Mohs micrographic surgery process.
  • To identify and mitigate potential errors at each surgical and histologic step.
  • To discuss procedural variations and offer protocols for error minimization and accuracy optimization.

Main Methods:

  • Literature search on PubMed for tissue mapping, orientation, and processing in MMS.
  • Review of existing techniques and proposed adaptations.

Main Results:

  • Identified various techniques for tissue orientation, transfer, flattening, inking, and mapping.
  • Presented a system to reduce errors in tissue transfer, in vivo/ex vivo identification, and flattening.
  • Discussed adaptations for improved accuracy in re-excision of subsequent Mohs layers.

Conclusions:

  • Procedural variations in MMS stem from diverse surgeon training and creativity.
  • Failure to address potential errors can lead to false negatives.
  • Mitigating errors is essential to maintain the high cure rate of MMS.