Reframing robotics in Mohs surgery for rare cutaneous sarcomas: conceptual promise and clinical realities in...

Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous sarcoma in which achieving histologically negative margins is paramount to minimizing recurrence. Mohs micrographic surgery (MMS) has transformed margin control in DFSP by enabling sequential, layer-by-layer excision with immediate histologic assessment, yet it remains technically challenging in anatomically complex sites and in cases with ambiguous deep or subclinical peripheral spread. Recent advances in robotic microsurgical platforms-characterized by tremor elimination, high-resolution imaging, and ergonomic interfaces-offer a conceptual framework for enhancing the precision and consistency of MMS. However, existing systems are optimized for deep-tissue procedures and lack the tactile sensitivity, superficial field adaptability, and integration with dermatologic mapping protocols essential for skin-level margin evaluation. Similarly, proposals to incorporate artificial intelligence for real-time histopathologic interpretation encounter significant regulatory, validation, and generalizability hurdles. We contend that while the convergence of robotics and AI with MMS holds promise for the future of dermatologic precision oncology, it remains a conceptual endeavor requiring fundamental reengineering, rigorous clinical validation, and regulatory alignment. We call for interdisciplinary collaboration among dermatologic surgeons, engineers, and pathologists to chart a realistic translational pathway toward surface-level robotic excisions in sarcoma care.