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

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.