Mohs micrographic surgery (MMS) is a well-established and renowned technique for the treatment of cutaneous neoplasms. Indications are mainly for nonmelanoma skin cancers like basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), but other rare, aggressive tumors can also be excised using the technique.
MMS boasts the lowest recurrence rates for BCC and SCC of any treatment modality.
A multidisciplinary approach may be instituted if the tumor is at high risk for metastases. This type of approach may require contact between multiple specialists such as Mohs surgeons, otolaryngologists, oculoplastic surgeons, ophthalmologists, facial plastic surgeons, surgical oncologists, medical oncologists, and radiation therapists.
MMS is an indicated procedure for cases with perineural invasion and involvement.
A Mohs surgeon follows tumor extensions until tumor-free margins are achieved. Thus, MMS is only functional when used to treat contiguous tumors.
The key indications for MMS include, but are not limited to, history of tumor recurrence, tumors that exhibit perineural invasion, tumors in high-risk anatomical locations, tumors with ill-defined clinical margins, and tumors with aggressive pathology and a high risk of metastasis.
PATIENT EDUCATION POINTS
MMS has a high cure rate, a superior tissue conservation profile, and exceptional cosmetic results, and it can be performed in an outpatient setting.
According to the American Academy of Dermatology, skin cancer is the most common cancer in the United States, with around 9500 people diagnosed every day. Additionally, it is estimated that one in five Americans will develop skin cancer in their lifetime.1 Perhaps the most alarming fact is that more people are diagnosed with skin cancer in the United States than all other cancers combined.2
Nonmelanoma skin cancers (NMSCs) are the most prevalent type of skin cancer and include basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs). Approximately 5.4 million cases of NMSCs are diagnosed each year in around 3.3 million Americans. BCC is the most common NMSC, thus making it the most common skin cancer with an estimated 4.3 million cases annually. SCC is the second most common NMSC and skin cancer, with an estimated 1.1 million cases annually.3 Research indicates the incidence of NMSCs has risen tremendously since 1976, with the highest rate of increase in people younger than 40.1 A recent study showed that the diagnosis and treatment of NMSCs in the United States increased by 77% between 1994 and 2014.1,3 The good news is that both BCCs and SCCs are highly curable if detected and treated early.
There are many risk factors behind the rapid rise in the prevalence of skin cancer, but the main culprit is ultraviolet (UV) light exposure. UV light exposure remains the single most preventable risk factor for skin cancer.4 The American Academy of Dermatology offers several recommendations to limit UV ray ...