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Mohs Micrographic Surgery

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1. Mohs micrographic surgery versus surgical excision for periocular basal cell carcinoma. (PubMed)

Mohs micrographic surgery versus surgical excision for periocular basal cell carcinoma. Basal cell carcinoma (BCC) is the commonest skin cancer in the white population. It is traditionally treated by surgical excision (SE) or by Mohs micrographic surgery (MMS).The objective of this review was to compare the effectiveness, cost, complications and acceptability of periocular BCCs when operated by MMS or SE.We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register

2014 Cochrane

2. Effectiveness of Mohs micrographic surgery for nonmelanoma skin cancer: a systematic review protocol. (PubMed)

Effectiveness of Mohs micrographic surgery for nonmelanoma skin cancer: a systematic review protocol. The objective of the review is to evaluate the effectiveness of Mohs micrographic surgery on the mortality, recurrence and quality of life of patients with nonmelanoma skin cancers when compared with other treatment modalities.Specifically, it aims to examine the effectiveness of Mohs micrographic surgery compared with other treatment modalities such as excisional surgery, curettage

2017 JBI database of systematic reviews and implementation reports

3. Contemporary Mohs Micrographic Surgery Histologic Preparation Methods, Laboratory-Assistive Personnel Training, and Practice Setting-A Survey Study. (PubMed)

Contemporary Mohs Micrographic Surgery Histologic Preparation Methods, Laboratory-Assistive Personnel Training, and Practice Setting-A Survey Study. The Mohs histotechnologist (MH) performs tissue preparation, sectioning, and staining, which are critical tasks in ensuring a successful Mohs micrographic surgery (MMS).To assess current norms in MH training, practice setting, and utilization of specific histologic techniques.A 16-question survey was created and distributed using Survey Monkey (...) to all members of the American Society for Mohs Histotechnology.Response rate was 30%. Most MHs received on-the-job training from other MHs or the Mohs surgeon. Mohs histotechnologists largely performed tasks related to tissue processing while Mohs surgeons generally illustrated the Mohs layer map. Automated routine staining was used in most laboratory tests, and laboratory tests used similar staining techniques. Most respondents worked in private offices verses academic centers. Total staining time

2019 Dermatologic Surgery

4. Factors Associated With Patient-Initiated Communication After Mohs Micrographic Surgery. (PubMed)

Factors Associated With Patient-Initiated Communication After Mohs Micrographic Surgery. Despite extensive counseling, patients commonly call with postoperative concerns after Mohs micrographic surgery (MMS).We sought to determine the incidence, reasons, and patient and surgical characteristics that lead to patient-initiated communication after MMS.A retrospective chart review of 1,531 patients who underwent MMS during the observational period was conducted. Demographics and perioperative (...) characteristics of patients who initiated communication were compared with a random sample of matched controls.Of the 1,531 patients who underwent MMS, 263 patients (17.2%) initiated 412 communication encounters within 90 days of surgery. Top reasons for patient-initiated communication included wound concerns, bleeding, and postoperative pain. Female patients and those with a larger surgical defect size (cm) were more likely to call postoperatively. Patients who underwent second intention healing, grafts

2019 Dermatologic Surgery

5. Mohs micrographic surgery for eyelid sebaceous carcinoma: a multicenter cohort of 360 patients. (PubMed)

Mohs micrographic surgery for eyelid sebaceous carcinoma: a multicenter cohort of 360 patients. The decision to perform Mohs micrographic surgery (MMS) or wide local excision (WLE) for eyelid sebaceous carcinoma (SC) is controversial.To compare local recurrence, metastasis, and tumor-related mortality of patients with eyelid SC who were initially treated with MMS versus WLE.A multicenter cohort study. Medical records were reviewed for factors associated with recurrence, metastasis and tumor (...) effect became nonremarkable for patients with pagetoid intraepithelial neoplasia (HR=1.73; 95%CI:0.37-8.21; p=0.488).Retrospective nature.MMS should be proposed for eyelid SC without orbital involvement to achieve recurrence control, however, this surgery did not change the long-term outcomes in terms of metastasis and tumor-related mortality. Patients with pagetoid intraepithelial neoplasia may require adjuvant measures.Copyright © 2019. Published by Elsevier Inc.

2019 Journal of American Academy of Dermatology

6. A randomised phase II study evaluating vismodegib as neoadjuvant treatment of basal cell carcinoma preceding Mohs micrographic surgery: results and lessons learned. (PubMed)

A randomised phase II study evaluating vismodegib as neoadjuvant treatment of basal cell carcinoma preceding Mohs micrographic surgery: results and lessons learned. Vismodegib is indicated for adults with metastatic or locally advanced basal cell carcinoma (BCC) inappropriate for surgery or radiotherapy. Neoadjuvant vismodegib has been reported to shrink locally advanced and high-risk BCC before surgery. It is unclear whether non-contiguous residual tumour remains after neoadjuvant treatment

2019 British Journal of Dermatology

7. Basal cell carcinoma of the vulva: treatment with Mohs micrographic surgery. (PubMed)

Basal cell carcinoma of the vulva: treatment with Mohs micrographic surgery. Vulval basal cell carcinomas (BCCs) are rare, representing < 5% of vulval malignancies and 1% of all BCCs. They often present with nonspecific symptoms and features that lead to large, poorly circumscribed and late-presenting lesions. Current and conventional treatments used to treat vulval BCC include cryotherapy, imiquimod and excision. However, recurrence rates as high as 20% have been reported with these treatments (...) . Furthermore, there are no current clinical guidelines for their management. We present the first reported series of patients with vulval BCC treated with Mohs micrographic surgery (MMS). We report seven cases of vulval BCC treated with MMS at a tertiary referral centre over 3 years. Follow-up was performed at 3 months and up to 3 years. Our series demonstrates that there were no postoperative complications, functional sequelae or recurrences up to the 3-year follow-up. We therefore recommend that MMS

2019 Clinical & Experimental Dermatology

8. Use of Eye Shields for Mohs Micrographic Surgery of the Eyelids and Periorbital Area. (PubMed)

Use of Eye Shields for Mohs Micrographic Surgery of the Eyelids and Periorbital Area. Internal eye shields are designed for use in periorbital procedures, but their use in Mohs micrographic surgery (MMS) of the eyelids has rarely been reported in the literature.The authors aim to discuss different types of internal eye shields as well as their indication, proper use, and potential complications.The authors performed a literature search on PubMed with the keywords "internal eye shield," "corneal (...) shield," "scleral shield," and "periorbital Mohs micrographic surgery" with no restriction on publication time frame due to the scarcity of relevant literature.Experts seem to agree that use of eye shield for MMS of the eyelids is a reasonable measure to undertake to prevent operative injuries. Although either plastic or stainless steel eye shield can be used, plastic eye shields are often preferred and recommended in procedures where electrosurgical devices need to be used.Although the authors

2019 Dermatologic Surgery

9. Mohs micrographic surgery versus wide local excision for melanoma in situ: analysis of a nationwide database. (PubMed)

Mohs micrographic surgery versus wide local excision for melanoma in situ: analysis of a nationwide database. With the rising incidence of melanoma in situ (MIS) or cutaneous melanoma, there is an increasing emphasis on the need to understand optimal treatment strategies. The current standard of surgical care is wide local excision (WLE). Alternative surgical techniques have been proposed including Mohs micrographic surgery (MMS). We aimed to compare survival rates following WLE versus MMS (...) surgery for MIS.We performed a retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) cancer registry. 24,515 cases of WLE were identified and compared with 4122 cases of MMS surgery for MIS.There was a significantly higher proportion of elderly patients aged ≥75 years in the MMS group compared to WLE (23.3% vs. 15.3%). The proportion of females was higher for WLE compared to MMS (48.8% vs. 40%). Facial MIS tumors were significantly higher for MMS, as were scalp/neck tumors

2019 International Journal of Dermatology

10. Tissue-sparing properties of Mohs micrographic surgery for infiltrative basal cell carcinoma. (PubMed)

Tissue-sparing properties of Mohs micrographic surgery for infiltrative basal cell carcinoma. Mohs micrographic surgery (MMS) should lead to tissue sparing of healthy skin compared to standard surgical excision, because smaller surgical margins are used.To quantify the tissue-sparing properties of MMS in primary basal cell carcinoma (BCC) with an infiltrative growth pattern.A prospective study including 256 primary BCC with an infiltrative growth pattern was performed. Tumor sizes were measured

2019 Journal of American Academy of Dermatology

11. Effect of Postoperative Telephone Calls on Patient Satisfaction and Scar Satisfaction After Mohs Micrographic Surgery. (PubMed)

Effect of Postoperative Telephone Calls on Patient Satisfaction and Scar Satisfaction After Mohs Micrographic Surgery. Mohs micrographic surgery is considered the gold standard for high-risk nonmelanoma skin cancer. Postoperative telephone follow-up (TFU) is linked to higher patient satisfaction; however, there are no randomized, blinded studies examining whether TFU after Mohs surgery improves patient satisfaction.To perform a randomized single-blinded prospective survey study examining (...) whether patient satisfaction or scar satisfaction varied between Mohs patients who received a postoperative call and patients who did not.Patients were enrolled into "post-op call" or "no post-op call" groups. Both arms completed surveys at suture removal and 3-month follow-up visits.One hundred four subjects were enrolled, and demographics, the number of Mohs stages, and type of repair were controlled. At suture removal, both arms reported similar overall high satisfaction on the 5-point Likert scale

2019 Dermatologic Surgery

12. Outcomes of Second Intention Healing of the Lower Eyelid Margin After Mohs Micrographic Surgery. (PubMed)

Outcomes of Second Intention Healing of the Lower Eyelid Margin After Mohs Micrographic Surgery. Lower eyelid margin defects can be a reconstructive challenge. A possible alternative is second intention healing of the lower eyelid margin.To determine the cosmetic outcomes and patient satisfaction of second intention healing of the lower eyelid margin after Mohs micrographic surgery (MMS).A retrospective chart review was performed on patients who underwent MMS of the lower eyelid margin. Patient (...) information was gathered on age, sex, diagnosis, postoperative size, number of Mohs stages, thickness of defect, and clinical photographs. The preoperative and postoperative photographs were evaluated with a physician assessment scale and patients completed a satisfaction survey.In all 17 patients (100%), the cosmetic results obtained were considered good to excellent. The objective outcomes were graded as excellent, very good, good, satisfactory, unsatisfactory, and poor. The patient satisfaction survey

2019 Dermatologic Surgery

13. Evaluation of a Peer-to-Peer Data Transparency Intervention for Mohs Micrographic Surgery Overuse. (PubMed)

Evaluation of a Peer-to-Peer Data Transparency Intervention for Mohs Micrographic Surgery Overuse. Mohs micrographic surgery (MMS) is a skin cancer treatment that uses staged excisions based on margin status. Wide surgeon-level variation exists in the mean number of staged resections used to treat a tumor, resulting in a cost disparity and question of appropriateness.To evaluate the effectiveness of a behavioral intervention aimed at reducing extreme overuse in MMS, as defined by the specialty (...) society, by confidentially sharing stages-per-case performance data with individual surgeons benchmarked to their peers nationally.This nonrandomized controlled intervention study included 2329 US surgeons who performed MMS procedures from January 1, 2016, to March 31, 2018. Physicians were identified using a 100% capture of Medicare Part B claims. The intervention group included physicians affiliated with the American College of Mohs Surgery, and the control group included physicians not affiliated

2019 JAMA dermatology (Chicago, Ill.)

14. Mohs micrographic surgery and dermatopathology concordance; An analysis of 1421 Mohs cases over 17 years. (PubMed)

Mohs micrographic surgery and dermatopathology concordance; An analysis of 1421 Mohs cases over 17 years. The success of Mohs micrographic surgery depends on the surgeon's ability to correctly interpret intraoperative frozen sections.This retrospective study analyzed the rate of concordance between Mohs surgeons and dermatopathologists in reading slides from Mohs surgery cases.A dermatopathologist reviewed all the frozen sections and the corresponding Mohs map for every 30th Mohs case (...) physicians who perform Mohs.Fellowship-trained Mohs surgeons show very high concordance with board-certified dermatopathologists in the accurate and precise interpretation of histology slides in the setting of Mohs micrographic surgery.Copyright © 2017. Published by Elsevier Inc.

2017 Journal of American Academy of Dermatology

15. Dermoscopy prior to Mohs Micrographic surgery does not improve tumour margin assessment and lead to fewer Mohs stages. (PubMed)

Dermoscopy prior to Mohs Micrographic surgery does not improve tumour margin assessment and lead to fewer Mohs stages. 28851098 2018 12 20 1365-2133 178 2 2018 02 The British journal of dermatology Br. J. Dermatol. Dermoscopy prior to Mohs micrographic surgery does not improve tumour margin assessment and leads to fewer Mohs stages. 565-566 10.1111/bjd.15903 Jayasekera P S A PSA 0000-0003-3849-3050 Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, U.K. Dodd J J

2017 British Journal of Dermatology

16. Association Between Surgeon-Specific Features and Number of Stages, Flaps, and Grafts in Mohs Micrographic Surgery: A Retrospective Observational Study of 59 Early-, Mid- and Advanced-Career Mohs Surgeons. (PubMed)

Association Between Surgeon-Specific Features and Number of Stages, Flaps, and Grafts in Mohs Micrographic Surgery: A Retrospective Observational Study of 59 Early-, Mid- and Advanced-Career Mohs Surgeons. There is limited data available to correlate Mohs surgeons' behavior and years of experience. Moreover, the recent standardization of Mohs surgery training programs may allow for the prediction of future trends in Mohs micrographic surgery surgery based on the current behavior of recently (...) trained Mohs surgeons.To better understand the relationship between surgeon-specific characteristics and the number of Mohs micrographic surgery total cases, stages per case, number of grafts, and number of flaps performed by each surgeon.Procedure data of 59 early-career, mid-career, and advanced-career Mohs surgeons were obtained from the website of the Centers for Medicare & Medicaid services.No statistically significant differences were identified in the number of stages per case between the 3

2017 Dermatologic Surgery

17. Mohs micrographic surgery versus surgical excision for periocular basal cell carcinoma. (PubMed)

Mohs micrographic surgery versus surgical excision for periocular basal cell carcinoma. Basal cell carcinoma (BCC) is the commonest skin cancer in the white population. It is traditionally treated by surgical excision (SE) or by Mohs micrographic surgery (MMS).  The objective of this review was to compare the effectiveness, cost, complications and acceptability of periocular BCCs when operated by MMS or SE.We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register

2012 Cochrane

18. Defining recurrence of nonmelanoma skin cancer after Mohs micrographic surgery: Report of the American College of Mohs Surgery Registry and Outcomes Committee. (PubMed)

Defining recurrence of nonmelanoma skin cancer after Mohs micrographic surgery: Report of the American College of Mohs Surgery Registry and Outcomes Committee. Standardized definitions and methods of surveillance for local recurrence of nonmelanoma skin cancer are critical in determining cure rates attributed to treatment modalities.We sought to offer a standard definition of local recurrence after surgical treatment of nonmelanoma skin cancer and to propose an acceptable surveillance period (...) and tracking methods.A literature search was performed for background definitions of local recurrence and tracking methods. The American College of Mohs Surgery (ACMS) Registry and Outcomes Committee then conducted a modified Delphi process to arrive at consensus definitions.We define local recurrence as a tumor with comparable histology, with contiguity to the surgical scar after treatment, and that arises within the area of the previously treated tumor.This project reports the results of a modified

2016 Journal of American Academy of Dermatology

19. Mohs Micrographic Surgery: Past, Present, and Future. (PubMed)

Mohs Micrographic Surgery: Past, Present, and Future. Mohs micrographic surgery (MMS) is a frequently used technique that provides total margin visualization for treatment of skin neoplasms.To provide a comprehensive review of MMS literature, focusing on its origins, evidence behind present-day uses of MMS, and future directions.A literature search was conducted using PubMed to identify articles pertaining to MMS.The fresh frozen technique led to widespread use of MMS in the 1970s. One (...) the adoption of noninvasive imaging, immunostaining, and digital technology.Mohs micrographic surgery is an effective treatment modality for numerous cutaneous neoplasms. It has achieved statistically significant superiority to surgical excision for the treatment of recurrent and high-risk NMSC. The future is likely to see increased use of noninvasive imaging, immunostaining, and digital technology.

2018 Dermatologic Surgery

20. A Four-Year Retrospective Assessment of Post-Operative Complications in Immunosuppressed Patients Following Mohs Micrographic Surgery. (PubMed)

A Four-Year Retrospective Assessment of Post-Operative Complications in Immunosuppressed Patients Following Mohs Micrographic Surgery. Many patients undergoing Mohs micrographic surgery for basal and squamous cell carcinomas are immunocompromised, yet post-operative complications associated with different types of immunosuppression are largely unstudied.To determine the incidence and nature of post-operative complications in immunosuppressed patients undergoing Mohs surgery.A retrospective

2018 Journal of American Academy of Dermatology

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