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Intraoperative Assessment of Resection Margins in Oral Cavity Cancer: This is the Way
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Incidental Histologic Findings During Mohs Micrographic Surgery: A Systematic Review.

Benjamin R Cooper1, Taha Rasul1, Anthony Concilla1

  • 1HCA Florida Orange Park Hospital, Orange Park, Florida.

Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [Et Al.]
|September 8, 2025
PubMed
Summary

Incidental findings during Mohs micrographic surgery (MMS) are common and often require further treatment. Awareness of these unexpected histologic findings is crucial for patient management and outcomes.

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Area of Science:

  • Dermatology
  • Surgical Pathology
  • Oncology

Background:

  • Mohs micrographic surgery (MMS) provides precise skin cancer excision with intraoperative margin assessment.
  • Incidental histologic findings, unexpected and unrelated to the primary lesion, are occasionally identified during MMS.
  • These incidental findings are not well-characterized in existing literature.

Purpose of the Study:

  • To systematically review published cases of incidental histologic findings during MMS.
  • To analyze the frequency, clinical implications, and management of these unexpected findings.

Main Methods:

  • A systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
  • Searches were conducted across PubMed, Wiley Online Library, Google Scholar, and Cochrane Library.
  • Data extraction included patient demographics, tumor details, incidental findings, implications, and treatments.

Main Results:

  • Twenty-nine studies involving 680 patients detailed incidental findings.
  • Basal cell carcinoma and squamous cell carcinoma were frequent incidental findings in one study (610 patients).
  • Other common incidental findings included benign syringomatous hyperplasia, syringomas, Merkel cell carcinoma, and melanoma, with 15.7% requiring further treatment; overall, 91.3% of all reported incidental findings necessitated additional treatment.

Conclusions:

  • Incidental findings during MMS can have significant clinical importance.
  • While many incidental findings are benign, some can impact patient prognosis and require altered management strategies.
  • Increased awareness and standardized reporting of these findings can improve patient outcomes.