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Background: Nonmelanoma skin cancer (NMSC) is the most common cancer worldwide and is frequently treated with Mohs micrographic surgery (MMS); however, data regarding characteristics of Hispanic patients undergoing MMS for NMSC are limited. Objective: To review the characteristics of Hispanic patients undergoing MMS for NMSC in the United States. Methods: A systematic review of PubMed articles from inception through September 2022 providing data for Hispanic patients undergoing MMS for NMSC was completed. Results: Overall, six publications met inclusion criteria and provided data for 2,856 Hispanic patients that underwent MMS for 2,955 NMSCs. Results demonstrate 60% of Hispanic patients were male, and the majority of NMSCs were basal cell carcinoma (BCC) (71%), followed by squamous cell carcinoma (SCC) (21%). Additionally, a larger percentage of pigmented BCC was found in the Hispanic population. While there is conflicting data in the literature, Hispanic patients may also have larger MMS defects when controlled for additional variables. Finally, over 64% of NMSCs in Hispanic patients were in high‐risk locations. Conclusion: Literature regarding the characteristics of Hispanic patients undergoing MMS for NMSC demonstrates most patients were male, BCC was the most common tumor subtype, and the majority of NMSCs were in high‐risk locations. [ABSTRACT FROM AUTHOR]

The article focuses on the effect of dermoscopy in the Mohs micrographic surgery (MMS) conducted for the nonmelanoma skin cancer (NMSC). Partiuclar focus is given to the two forms of NMSC basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) along with the techniques used to reduced the stages of MMS which include confocal microscopy and ultrasound. Result of the study conducted on patients to check the effect of dermoscopy in order to reduce the stages of MMS is also discussed.

Finally, only one study (a large cohort of 80 penile cancer patients) published patient-related outcomes, showing a 97.56% satisfaction rate with this procedure, with 57.5% and 66% of patients reporting unchanged sexual and urinary function, respectively.7 In conclusion, MMS is an effective OPT in penile SCC. After data collection, recurrence rates of MMS in penile SCC were compared to documented recurrence rates for MMS in non-penile SCC, as well as to the recurrence rates of other OPTs in penile SCC. The average lesion diameter before surgery was 25.4 mm (mean range: 19-28.7 mm), with a mean follow-up after MMS of 54.2 months (mean range: 17.5-97.4 months).3-9 Nineteen tumors locally recurred after surgery, generally treated with a second MMS. [Extracted from the article]

Cupcake Mohs: A simple analogy to differentiate Mohs micrographic surgery and "bread-loaf" processing While the cupcake method is advantageous in "physical" visualization and allows comparison to the bread-loaf method, Mohs surgeons should use the explanation that most fits their comfort and patients. Dear Editor, Patient education prior to Mohs micrographic surgery (MMS) is essential to clarify its benefits and risks and decrease patients' anxiety.1 The technique of MMS may be difficult to conceptualize and, therefore, Mohs surgeons need effective educational methods for patients, often needing the aid of a visual cue. [Extracted from the article]

Cutaneous mesenchymal tumors (CMT) are rare tumors with wide clinicopathologic heterogeneity. Treatment of malignant cutaneous mesenchymal tumors traditionally includes wide local excision (WLE), though Mohs micrographic surgery (MMS) has been increasingly used. A PubMed literature review of articles from inception until September 2019 related to malignant CMT and surgical treatment with MMS or WLE was completed. Dermatofibrosarcoma protuberans treated with MMS recurred in 1.2% of patients with no reported metastasis. Atypical fibroxanthoma treated with MMS recurred and metastasized in 2.7 and 2.5%, respectively. Undifferentiated pleomorphic sarcoma treated with MMS recurred in 32% with an unknown metastatic rate. Superficial leiomyosarcoma treated with MMS recurred in 3.8% with no reported metastasis. Cutaneous angiosarcoma and myofibrosarcoma treated with MMS have shown no recurrence or metastatic disease, but literature is sparse. The rarity of malignant CMT and the lack of comparative data on treatment make conclusive treatment recommendations difficult. However, recent literature suggests MMS is a useful option and potentially a superior treatment for primary cutaneous mesenchymal tumors. [ABSTRACT FROM AUTHOR]

This information challenges recent studies describing MMS as an infrequently used modality for porocarcinoma.[4] Curiously, Western and rural cases were more likely to use MMS for AC. The purpose of this study was to describe demographics, investigate prognoses, and analyze Mohs micrographic surgery (MMS) and wide local excision (WLE) use rates for AC. Information on surgical management and survival for adnexal carcinomas (AC) lacks strong evidence-based guidance. [Extracted from the article]

Background: 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. Methods: 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. Results: 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. After adjustment for confounding factors, there was no significant difference in cancer‐specific survival (HR 0.928, 95% CI 0.596–1.446, P = 0.74) and overall survival (HR 1.006, 95% CI 0.896–1.129, P = 0.924). Conclusion: Adjusted analyses demonstrated no differences in overall survival or cancer‐specific survival between MIS patients treated with MMS compared with WLE. [ABSTRACT FROM AUTHOR]

Background: The use of Mohs micrographic surgery (MMS) for rare cutaneous tumors is poorly defined. We aim to describe the demographics, tumor presentation and topography, surgery characteristics and complications of MMS for rare cutaneous tumors in a national registry. Methods: Prospective cohort study of patients treated with MMS in Spain between July 2013 and June 2018. The inclusion criteria were patients with cutaneous tumors with final diagnosis different from basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, or any kind of melanoma. Results: Five thousand and ninety patients were recorded in the registry, from which only 73 tumors (1.4%) fulfilled the inclusion criteria: atypical fibroxanthoma (18), microcystic adnexal carcinoma (10), extramammary Paget's disease (7), Merkel cell carcinoma (5), dermatofibroma (4), trichilemmal carcinoma (4), desmoplastic trichoepithelioma (4), sebaceous carcinoma (3), leiomyosarcoma (2), porocarcinoma (2), angiosarcoma (2), trichoblastoma (1), superficial acral fibromyxoma (1), and others (10). No intra‐surgery morbidity was registered. Postsurgery complications appeared in six patients (9%) and were considered mild. Median follow‐up time was 0.9 years during which three Merkel cell carcinomas, one angiosarcoma, one microcystic adnexal carcinoma, and four others recurred (12.3%). Conclusion: This national registry shows that rare cutaneous tumors represent a negligible part of the total MMS performed in our country with a low complication rate. [ABSTRACT FROM AUTHOR]

Background: Dermatologists perform a variety of procedures including excisions, biopsies, and other minor surgical procedures. Patients can experience anxiety in anticipation of their surgeries or may develop anxiety during the procedure. Since most dermatologic procedures occur with the patient awake and alert, the physician can offer comforting methods to alleviate some of that anxiety. Aims: We wanted to provide a review of available methods that dermatologists can use to reduce patient anxiety. Materials & Methods: In this paper, we review the current literature on methods that can be used in dermatology offices to reduce overall patient anxiety levels. Results: In the preoperative stage, providers can offer educational content to explain the procedure to their patients. Whether it be through telephone calls, educational videos, or utilization of visual models, educating the patient regarding their procedure may reduce their anxiety. Intraoperatively, there are multiple methods that can be used such as music, guided imagery, coloring books, medications, hypnosis, and distraction techniques. Discussion & Conclusion: There is a variety of approaches that can be easily implemented in the office and can help in reducing the anxiety of the patients to allow for a pleasant patient experience and an overall satisfactory procedure outcome. [ABSTRACT FROM AUTHOR]

Background: Artificial intelligence (AI) and large language models (LLMs) transform how patients inform themselves. LLMs offer potential as educational tools, but their quality depends upon the information generated. Current literature examining AI as an informational tool in dermatology has been limited in evaluating AI's multifaceted roles and diversity of opinions. Here, we evaluate LLMs as a patient‐educational tool for Mohs micrographic surgery (MMS) in and out of the clinic utilizing an international expert panel. Methods: The most common patient MMS questions were extracted from Google and transposed into two LLMs and Google's search engine. 15 MMS surgeons evaluated the generated responses, examining their appropriateness as a patient‐facing informational platform, sufficiency of response in a clinical environment, and accuracy of content generated. Validated scales were employed to assess the comprehensibility of each response. Results: The majority of reviewers deemed all LLM responses appropriate. 75% of responses were rated as mostly accurate or higher. ChatGPT had the highest mean accuracy. The majority of the panel deemed 33% of responses sufficient for clinical practice. The mean comprehensibility scores for all platforms indicated a required 10th‐grade reading level. Conclusions: LLM‐generated responses were rated as appropriate patient informational sources and mostly accurate in their content. However, these platforms may not provide sufficient information to function in a clinical environment, and complex comprehensibility may represent a barrier to utilization. As the popularity of these platforms increases, it is important for dermatologists to be aware of these limitations. [ABSTRACT FROM AUTHOR]

Sebaceous carcinoma (SC) is a rare neoplasm affecting periocular and extraocular sites. If inadequately treated, it can recur and cause morbidity. Specific management guidelines have not been established. Wide local excision (WLE) has been traditionally used; however, Mohs micrographic surgery (MMS) can be advantageous because of complete margin assessment and tissue‐sparing nature. This analysis aims to systematically review the surgical modalities used for the management of SC. Articles meeting eligibility criteria were identified using MEDLINE (via PubMed), Embase, Cochrane, and Scopus databases. All studies investigating surgical management of SC with WLE or MMS were considered. Seventy studies met inclusion criteria, including retrospective cohort studies, case series, and case reports. WLE was used in 32 studies, MMS in 29, and MMS and WLE in 9. Subgroup analysis showed that MMS has lower recurrence rates. For WLE, local, regional, and distant recurrence rates were 23.4%, 13.3%, and 11.0%, respectively, and for MMS, 6.8%, 4.3%, and 4.6%, respectively. Patients treated with WLE were more likely to have local recurrence than patients treated with MMS (P = 0.001). WLE cases were more likely to have a regional (P = 0.05) and distant recurrence (P = 0.001). Limitations of the study include heterogeneity of case reports, case series, and retrospective studies, variable follow‐up times between the two groups, and large tumors included in the WLE category. In addition, disease‐specific survival was not evaluated. MMS cases showed a superior outcome for local, regional, and distant recurrence, making it a good option for the management of SC. [ABSTRACT FROM AUTHOR]

Background: The nose is a common site for the development of skin cancers. Mohs micrographic surgery (MMS) is a highly curative treatment for skin cancer of the nose. Reconstruction of MMS defects on the nose, especially on the distal aspect, can be challenging given the proximity of multiple subunits and limited adjacent tissue reservoirs. Our goal was to describe our experience using a nasal tip rotation flap (NTRF) for MMS defects on the distal nose. Methods: A retrospective review of all MMS cases at multiple institutions between June 2018 and June 2022 was undertaken. Cases that used an NTRF to repair the MMS defect(s) were selected, and data were collected on patient demographics, tumor type, anatomical location of the tumor, preoperative and postoperative size, number of stages needed to clear the tumor, repair dimensions, and any postoperative complications. Results: A total of 66 cases that utilized an NTRF for reconstruction were included. The mean preoperative tumor size was 0.8 cm (range: 0.3–1.6 cm), and the mean defect size was 1.2 cm (range: 0.7–1.9 cm). The defects were most commonly on the nasal tip. There were no significant complications observed. Conclusions: The nasal tip rotation flap is a reliable reconstruction option for MMS defects of the distal nose. This flap can be used for defects that involve the nasal tip, soft triangle, and/or portions of the ala, including the alar rim. [ABSTRACT FROM AUTHOR]

Mohs micrographic surgery (MMS) is the gold standard for removing basal cell carcinomas (BCCs) due to its ability to guarantee 100% margin evaluation through frozen section histopathology, offering the highest cure rate among current treatments. However, noninvasive imaging technologies have emerged as promising alternatives to clinical assessment for defining presurgical margins. This systematic scoping review examines the efficacy of these imaging modalities, focusing on those approved for clinical use by the United States Food and Drug Administration (FDA) or the European Medicines Agency (EMA). A systematic search of EMBASE, Scopus, PubMed, and the Cochrane Public Library databases identified 11 relevant studies out of 2123 records, encompassing 644 lesions across five imaging techniques. The findings suggest that dermoscopy, high‐frequency ultrasound (HFUS), optical coherence tomography (OCT), line‐field optical coherence tomography (LC‐OCT), and reflectance confocal microscopy (RCM) show potential in detecting BCC margins, which could enhance MMS by providing better preoperative planning, informing patients of expected defect size, aiding in reconstruction decisions, and reducing overall procedure costs. This review discusses the benefits and limitations of each technique, offering insights into how these innovations could influence the future of BCC management. Emerging imaging techniques could enhance MMS by improving BCC margin assessment and reducing costs. Their adoption will depend on price and ease of use. [ABSTRACT FROM AUTHOR]

Although most cases of extramammary Paget's disease (EMPD) are localized to the intraepidermal, the extensive subclinical extension can lead to high rates of marginal recurrence with wide local excisions and topically destructive treatments. Recurrence rates of EMPD treated with Mohs micrographic surgery (MMS) without immunohistochemical staining are better but variable. Here, we describe our multidisciplinary approach for treating large EMPD tumors of the anogenital region involving critical anatomy using MMS for peripheral margin clearance (moat method) and intraoperative CK7 immunostaining. Our clinical pearls for the management of anogenital EMPD are based on 53 multidisciplinary cases treated at the author's institution between 2014 and 2020. [ABSTRACT FROM AUTHOR]

Abstract: Background: The two main tumors treated with Mohs micrographic surgery (MMS) are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). There are no studies analyzing whether MMS is different when treating these two types of tumors. Objective: We aim to compare the characteristics of the patients, the tumors, and MMS, and first‐year follow‐up of MMS in BCC and SCC. Methods: REGESMOHS is a prospective cohort study of patients treated with MMS. The participating centers are 19 Spanish hospitals where at least one MMS is performed per week. Data on characteristics of the patients, tumors, and surgery were recorded. The follow‐up was done with two visits: the first visit within 1 month after surgery and the second one within the first year. Results: From July 2013 to April 2017, a total of 2,669 patients who underwent MMS were included in the registry. Of them, 2,448 (93%) were diagnosed with BCC, and 181 (7%) were diagnosed with SCC. Patients with SCC were older than those with BCC (median age 73 years vs. 68 years) and presented immunosuppression more frequently. The tumor size was significantly larger in the SCC group. Regarding surgery, deeper invasion was more frequent in SCC, resulting in larger defects. Despite this, SCC did not require more stages to get clear margins or more time in the operating room. Incomplete Mohs was more frequent in the SCC group (6%) than in the BCC group (2%). The incidence of perioperative complications was higher when treating SCC. There were more relapses in the first‐year follow‐up in the SCC group. Conclusion: There are significant differences when comparing MMS in BCC and SCC. Knowledge of these differences can help to prepare the patient and plan the surgery, optimizing results. [ABSTRACT FROM AUTHOR]

Background The incidence of basal cell carcinoma ( BCC) has increased during the previous decade. Mohs micrographic surgery ( MMS) is the gold standard technique for BCCs. The aim of this study was to investigate the recurrence rate of periocular BCCs following MMS in a regional Mohs treatment facility in the United Kingdom. Materials and methods The study comprised a retrospective case note review of 480 patients who underwent MMS from 2001 to 2006 for periocular BCC. Patients were identified via hospital coding databases. Medical records were reviewed, and the parameters collected include age, gender, previous BCCs and treatment modality, postoperative complications and subsequent management, site, size of lesion, histological subtype, and recurrence following MMS. Results Three hundred and ninety of the 480 patients identified were included. The remaining patients had died before the 5-year analysis (65), were lost to follow-up (20), or were identified as having Gorlin's syndrome (5). The majority of BCCs were 6-10 mm (42%) and nodular (45%). Six recurrences were identified (1.5%), including one (0.3%) primary BCC and five (6.5%) recurrent BCCs at the time of the MMS. The mean follow-up was 30 months (range 1-120 months). Conclusion For BCC in the periocular region, MMS should be the treatment of choice for both primary and recurrent periocular BCCs. The increased recurrence rate, demonstrated by recurrent BCCs, highlights the need for a comprehensive follow-up. [ABSTRACT FROM AUTHOR]

Microcystic adnexal carcinoma (MAC) is a rare and aggressive malignant tumor of the sweat glands. Clinically, it often presents as a firm subcutaneous nodule on the head and neck regions. On histology, MAC exhibits both pilar and sweat duct differentiation with a stroma of dense collagen. It often extends beyond the clinical margins with local spreading in the dermal, subcutaneous, and perineural tissue planes. It has a high local recurrence rate after standard excision. Recent preliminary reports have indicated more favorable cure rates with Mohs’ micrographic surgery (MMS).To present our data on four cases of MAC treated by MMS. We also compared our findings with more recently reported series in the English language literature.We reviewed the medical records of four patients (two males and two females) with MAC treated by MMS over the last 3 years. We also obtained follow-up data.In all four patients with MAC treated by MMS, there were no recurrences, with a mean follow-up of 1 year.We report an additional four MAC cases treated by MMS. The accumulated data continue to confirm that, if the diagnosis of MAC is made early, and if the anatomic location is accessible to excision by MMS, a favorable outcome can be expected. [ABSTRACT FROM AUTHOR]

Background Erosive adenoma of the nipple ( EAN) is a benign condition that involves major ducts of the nipple. Its clinical presentation may resemble other disorders. Complete removal of the nipple is often suggested because of frequent relapse. However, adverse cosmetic and functional results have prompted clinicians to look for other more conservative options. Aims To present a case of EAN successfully treated using Mohs micrographic surgery ( MMS) and summarize differential diagnosis and treatment. Materials and Methods A 40-year-old woman with EAN was diagnosed by immunohistochemical markers after clinical suspicion. We have reviewed other cases treated with MMS in the literature. Results In this patient, lesion size was 0.8 cm and the margin specimen was 1 × 0.9 × 0.2 cm, with EAN as histopathologic diagnosis. No atypia or malignancy was reported. Final esthetic outcome was reached with only one session, under local anesthesia and on an outpatient basis. Discussion Dermatologic lesions appearing on the nipple's surface should be closely followed. Paget's disease, carcinoma or proliferative lesions like EAN have to be considered, and such conditions require different surgical approaches. Traditional complete removal of the nipple is performed in many cases, but it may result in over-treatment and unfavorable cosmetic outcome. MMS is frequently used in dermatologic surgery to treat malignant lesions with a high cure rate, avoiding excess tissue excision and leading to better patient satisfaction. Conclusion EAN can be successfully treated by minimal resection, especially if early diagnosis is done. MMS offers a better aesthetic outcome than traditional total excision. [ABSTRACT FROM AUTHOR]

Dear Editor, Dermoscopy has a high accuracy for diagnosing basal cell carcinoma (BCC); however, few studies have histologically evaluated its accuracy of margin assessment.1,2 Previous studies included selected subtypes, and accuracy was based on "bread-loaf" sections, examining <1% of the peripheral margin.1,2 In the present study, we evaluated dermoscopy accuracy of distinct BCC subtypes with Mohs micrographic surgery (MMS) allowing 100% histological margin assessment. To determine dermoscopic accuracy, tumors were divided into two groups: Accurate dermoscopy: lateral margins cleared on the first MMS stage (71.7%), and Inaccurate dermoscopy: >1 stage to clear margins. [Extracted from the article]

The article explores sex disparities in surgical treatment for extramammary Paget disease (EMPD), a rare dermatologic condition primarily affecting genital skin. The study, based on SEER data, reveals that males are significantly more likely than females to receive Mohs micrographic surgery (MMS) for EMPD, while females are more likely to undergo wide local excision (WLE). The findings suggest that women may have their lesions managed by gynecologists, leading to lower rates of MMS utilization. The study highlights the importance of multidisciplinary approaches and tissue-sparing techniques in treating EMPD, particularly in female patients. [Extracted from the article]

Background: Nail apparatus melanoma is a malignant tumor with a high incidence in Chinese melanoma patients. Slow Mohs micrographic surgery is an emerging technique for treating nail apparatus melanoma in situ (NAMIS). Objective: This study evaluated the efficacy and safety of slow Mohs micrographic surgery for treating NAMIS. Methods: Patients were enrolled in this retrospective study and treated in a single center from October 1, 2016, to June 30, 2022. Each patient underwent standard slow Mohs micrographic surgery, and follow‐up was regularly conducted at clinics. Results: Ten patients were enrolled in the study. Two patients underwent one Mohs stage, seven underwent two Mohs stages, and one underwent seven Mohs stages. The resection margin ranged from 5 to 25 mm. No severe complications were reported in the treatment, and recurrence of NAMIS was not observed during the follow‐up period. Conclusion: Slow Mohs micrographic surgery is a valuable surgical method to treat NAMIS that preserves digit function and can be well tolerated by patients. [ABSTRACT FROM AUTHOR]

The article discusses the use of artificial intelligence, specifically large language models (LLMs), in providing patient education, focusing on Mohs micrographic surgery (MMS). While LLMs like ChatGPT and Google Bard/Gemini are generally accurate and appropriate for patient education, they often lack the necessary specificity and conciseness required for effective communication in a medical setting. The study emphasizes the importance of refining AI tools to meet the standards for patient education, highlighting the need for ongoing validation, standardization, and collaboration with developers. Overall, while LLMs offer advancements in medical education, they should complement rather than replace the human elements of patient care. [Extracted from the article]

Background: Merkel cell carcinoma (MCC) of the skin is most commonly treated with wide local excision (WLE) with or without adjuvant radiation therapy (RT). Mohs micrographic surgery (MMS) as monotherapy may offer an alternative treatment modality. The purpose of this study is to describe outcomes of patients with primary Stage I/II MCC treated with MMS alone and no RT. Methods: A retrospectively collected sample of 56 MCCs treated with MMS was studied over an 18‐year period. Tumor and treatment characteristics were described, and follow‐up was assessed. Results: A total of 56 primary Stage I/II MCCs in 53 patients were treated with MMS as monotherapy from April 2001 through July 2019. Patients were followed for an average of 4.6 years (median 2.7 years, range 0.8 to 16.9 years), of which 19 (33.9%) had follow‐up of 5 years or more. There were no local recurrences due to inadequate excision. The 5‐year Kaplan‐Meier MCC‐specific survival for AJCC8 Stage I and AJCC8 Stage IIA were 91.2% and 68.6%, respectively. Conclusion: In comparison to historical controls, Mohs surgery offers a survival that is at least as good as WLE +/‐ RT, with the added benefits of no need for adjuvant RT or the need for further surgery for treatment of local recurrence. [ABSTRACT FROM AUTHOR]

Background: Basal cell carcinoma (BCC) is the most common cutaneous malignancy. Multiple risk factors are associated in the development of BCC, with ultraviolet light and genetics playing major roles. Aims: The departments of dermatology, medical oncology, ophthalmology, otorhinolaryngology, head and neck surgery, plastic surgery, and radiation oncology of the Jose R. Reyes Memorial Medical Center, Manila, Philippines, have convened and formulated consensus statements on the diagnosis and management of BCC patients seen in the institution. Conclusion: The summary of the recommendations is: (1) Surgery is the treatment of choice for BCC. The range of margins (2–4 mm) depends on the type of BCC. (2) Mohs micrographic surgery (MMS) is indicated for high risk BCC. (3) Topical treatment with imiquimod or 5‐flourouracil (5‐FU) may be used for superficial BCC. (4) Destructive methods (cryotherapy, curettage and electrodessication, photodynamic therapy) may be used for low risk BCC. (5) Medical and/or radiation therapy is advised for cases where surgery is contraindicated or tumor is not amenable to surgery. Metastasis of this malignancy is rare. Follow‐up, which may continue up until 2 years, is recommended for high risk BCC. [ABSTRACT FROM AUTHOR]

Abstract: Background: Mohs micrographic surgery (MMS) is used to treat cutaneous malignancies in locations to maximize tissue sparing. The authors’ aim is to demonstrate the utility of conservative thickness layers (CTL) in MMS and review patient and tumor characteristics and the potential anatomic locations where this technique may be most useful. Methods: We performed a retrospective chart review of patients with tumors treated with CTL in MMS of 339 tumors, recording patient demographics, tumor characteristics, MMS stages for clearance, repairs, complications, and follow‐up. Results: A total of 339 tumors were treated with CTL. The most common site was the leg (28.6%), with 77.4% of these being female. The next most common sites were nose (24.5%), scalp (13.9%), and back (11.5%). Most tumors were cleared with one layer (269), but some required two layers (42), three layers (11), and four layers (1). A total of 264 tumors were left to granulate, while 75 of the nasal tumors had immediate dermabrasion. Conclusion: In the properly selected patient and anatomic location, CTL taken as the first stage in MMS can be an effective and time‐saving technique, leaving wounds in optimal condition for granulation with a low complication rate. Tissue sparing may allow for more reconstructive options. [ABSTRACT FROM AUTHOR]

The vulva is an unusual site for basal cell carcinoma (BCC). Vulvar BCC accounts for <1% of all BCCs and <5% of all vulvar malignancies. We report the case of an 83 year‐old woman who presented with a 2‐month history of a tender labial growth, with histopathology confirming nodular BCC. We conducted a systematic literature review of the characteristics of reported cases of vulvar BCCs. A comprehensive systematic review of articles indexed for MEDLINE and Embase yielded 96 reports describing 437 patients with 446 BCCs of the vulva. The mean age at presentation was 70 (range 20–100). Most women had no underlying vulvar disease. Approximately 60% of cases were of the nodular subtype. Treatment approach varied widely with over half of cases treated with wide local or local excision. Mohs micrographic surgery (MMS) for vulvar BCC was first reported in 1988 with seven total MMS cases reported. Twenty‐three cases of recurrence have been reported; 21 of these cases after local excision but none following MMS. Vulvar BCC is a rarely reported cancer that affects older women predominantly. MMS represents a promising treatment for BCC in this anatomic location. [ABSTRACT FROM AUTHOR]

Background Eccrine porocarcinoma ( EPC) is a rare malignant tumor of the eccrine sweat gland. It is a potentially fatal neoplasm that is locally aggressive and commonly recurs. Wide surgical excision has traditionally been the treatment of choice and is curative in approximately 70-80% of cases. The disease is metastatic to lymph nodes and distant sites in 20% and 10% of cases, respectively. Metastatic EPC has not shown any great response to adjuvant chemotherapy or radiation. Objective The purpose of this study was to evaluate the efficacy of Mohs micrographic surgery ( MMS) for EPC as an alternative to wide local excision. Methods Five patients diagnosed with EPS between 2011 and 2014 at the University of Louisville and treated with MMS were studied. Recurrence-free periods subsequent to the treatment of EPC with MMS were measured. Results The five patients with EPC treated by MMS remained recurrence-free for a mean of 11 months (range: 2-26 months). Conclusions Mohs micrographic surgery is a highly effective treatment for EPC. Given the high rate of recurrence, propensity for lymph node metastases, and the often ineffective options for treating advanced disease, MMS should be considered in the treatment of all cases of EPC. [ABSTRACT FROM AUTHOR]

Background: The incidence of basal cell carcinoma (BCC) in younger individuals has increased in recent decades. However, the characteristics of BCCs in this population, especially in Ibero‐Latin American countries, have not been completely defined. Objective: To describe the demographic, clinical, and histopathological characteristics of BCCs in patients younger than 40 treated with Mohs Micrographic Surgery (MMS). Materials and Methods: A multicenter, retrospective study conducted between January 2009 and December 2014, in five Ibero‐American countries, included biopsy‐proven BCCs in patients younger than 40 that were treated with MMS. Demographic, clinical, histopathological, and surgical characteristics were described. Results: The study included 301 tumors in 241 patients, of whom 61% were female. The most common Fitzpatrick phototype was III. The most common histological subtypes were nodular (37.5%) and infiltrative (18.9%). Perineural invasion was encountered in 1.7%, and tumor clearance was achieved in 87.4% within two stages of MMS. Conclusions: This is the first Ibero‐Latin American transnational study describing the characteristics of BCCs in young patients treated with MMS. Despite darker skin phototypes in this population, BCCs can occur in early ages and may present with aggressive features. Therefore, MMS may be considered an appropriate first‐line treatment option in this population. [ABSTRACT FROM AUTHOR]

Background. Basal cell carcinomas (BCC) have increased vasculature, therefore, blood flow within the tumor may be greater than normal surrounding skin. We attempted to detect the difference in blood flow between the tumor and uninvolved surrounding skin utilizing laser doppler velocimetry (LDV). Methods. Ten patients with 14 BCC were studied. Using LDV, we calculated the size of the tumor based on margin assessment as predicted by the measured difference in blood flow and compared this size with the clinically predicted size and the size of the defect after Mohs micrographic surgery (MMS). Results. Clinical evaluation of tumor size prior to MMS did not correlate with the size of the surgical defect after MM5; however, correlation was found between the predicted size of the tumor as determined by LDV and the defect after MMS. Conclusions. Tumor size of BCC as predicted by measured differences in blood flow using LDV correlated with the size of the surgical defect after MMS. This suggests that LDV was able to detect the difference in blood flow between the tumor and uninvolved surrounding skin. [ABSTRACT FROM AUTHOR]

The article discusses a case of retiform hemangioendothelioma (RH), a rare vascular tumor that is locally aggressive. The patient, a 20-year-old female, presented with a red plaque on her lower leg, which was successfully treated with Mohs micrographic surgery (MMS). The article highlights the challenges in diagnosing RH, the importance of clear margins in surgical excision, and the potential benefits of MMS in treating this rare tumor. The authors suggest further research to establish broader clinical guidelines for the treatment of RH. [Extracted from the article]

Background The macrophages associated with solid tumors are related to the progression or regression of tumors, depending on the differentiation in M1 or M2. M2 subtype promotes angiogenesis, remodeling, and tissue repair (tumor proliferation). In contrast, M1 produces toxic mediators and presents antigens, destroying microorganisms and tumor cells. The microenvironment of most aggressive forms of basal cell carcinoma ( BCC) shows an increase in macrophages due to M2 phenotype compared to noninvasive forms. The treatment of nodular BCC by Mohs micrographic surgery ( MMS) provides high cure rates, but relapses can occur. Aims To compare the total population of macrophages and their subpopulations M1 and M2 in cases of recurrent and nonrecurrent nodular BCC after excision by MMS. Materials & Methods Histological sections obtained from paraffin blocks of nine cases of recurrent nodular BCC after MMS and 18 cases of nonrecurrent nodular BCC operated by MMS were immunostained for iNOS, CD204, CD163, and CD68. The expression of these markers was analyzed by image analysis. Results No significant differences were found between the groups in relation to the average percentage of M1 cells, M2 cells, and total cells. Discussion and Conclusion A relationship was not seen between tumor-associated macrophages (TAM) and tumor recurrence. [ABSTRACT FROM AUTHOR]

Background Dermatofibrosarcoma protuberans (DFSP) is an uncommon intermediate-grade fibrohistiocytic sarcoma. It occurs most often in adults aged 20-50 years and is associated with local invasion and a high recurrence rate. Uncontrolled local disease or metastases may result in death. Treatment has involved wide excision, Mohs micrographic surgery (MMS) and other approaches. The purpose of the current study was to review our experience with MMS in the treatment of patients with DFSP over the past six years. Methods We carried out a retrospective chart review for all patients treated with MMS at the Hospital Italiano de Buenos Aires during a six-year period to October 2009. Patient data included age and sex, site, and prior surgical treatment (if any) of the tumor and details of the Mohs procedure. Results Eleven patients were treated for DFSP. Four (36.4%) patients had been previously treated with a standard wide excision. Three (27.3%) of the 11 tumors were located on the back, four (36.4%) on the upper extremity, one (9.1%) on the lower extremity, and three (27.3%) on the trunk. Mean lesion size at presentation was 5.16 cm2, and mean defect size was 12.65 cm2, yielding a difference of 7.49 cm2 and a ratio (defect size/lesion size) of 2.45. No tumors recurred after MMS. Conclusions The recurrence potential of DFSP is directly related to the extent of resection. Mohs micrographic surgery with continuous histological margin control allows for maximum tissue preservation and low recurrence rates and is rapidly emerging as a first-line treatment modality for this condition. [ABSTRACT FROM AUTHOR]

We are writing to address a relevant discrepancy recently noted within the Mohs micrographic surgery (MMS) appropriate use criteria (AUC) algorithm. The AUC is based on the AAD/ACMS/ASDSA/ASMS appropriate use criteria for MMS published in 2012.[1] The AUC software application is a valuable tool used to stratify patients for MMS. If NMSC is not stratified by the risk factor of recurrence, then a lower risk tumor (primary superficial BCC in an immunocompromised patient with a size of 2 cm) obtains a higher score (AUC 5) than a higher risk tumor (recurrent primary superficial BCC in an immunocompromised patient with a size of 2 cm - AUC score of 3). [Extracted from the article]

Background When possible, surgery is the treatment of choice for cutaneous carcinomas, as it allows to us perform the anatomopathological study and control the surgical margins. Mohs micrographic surgery ( MMS) controls 100% of the margins, maintains a larger amount of healthy tissue, and a fewer number of recurrences are seen. Large limb surgical defects after MMS are a challenge. Within the different kind of flaps, the keystone flap, which is a fasciocutaneous island advancement flap, is an option. Methods A descriptive study was carried out on the extremity defects that occurred after MMS, which were reconstructed with the modified keystone type flap, during the years 2013-2014 in our department. Results Six patients underwent reconstruction surgery with the modified keystone flap. The tumor types presented by the patients were four squamous cell carcinomas and two basal cell carcinomas. Locations of the repaired defects were three in the leg, two in the thigh, and one in the forearm. The average size of the repaired defects was 3.1 cm. The procedure was well tolerated in all cases. No complications were observed, such as postoperative bleeding, infection, or necrosis, or dehiscence of the suture. Conclusions The modified keystone flap has been very helpful for solving the limb defects of these six patients, although they were not compared with other types of reconstruction. [ABSTRACT FROM AUTHOR]

4 c 18/24 were treated with conventional surgeries prior to entering our institution: twelve with one surgery, four with two surgeries, and two with three surgeries. Cutaneous leiomyosarcoma (LMS) is a rare neoplasm of muscular origin. In patients with a positive margin(s), the residual tumor is excised with additional 0.5 margins, and the process is repeated.[3] 3 b FNCLCC: Histological classification of sarcomas, which determines the prognosis. [Extracted from the article]

The rim and deep margin MMS technique can be employed for cutaneous surgery of patients on anticoagulant or antithrombotic agents, with large tumors, or with tumors in highly vascular locations. A retrospective analysis of complication rates in Mohs micrographic surgery patients with clinically large tumors and tumors with aggressive subclinical extension. Tumor characteristics of Mohs surgery patients in Ottawa, Canada versus Houston, Texas-a consequence of access to care?. [Extracted from the article]

This article discusses the use of anti-epithelial cell adhesion molecule (EpCAM) immunostain in the histologic evaluation of aggressive basal cell carcinomas (BCCs) during Mohs micrographic surgery (MMS). The traditional method of using hematoxylin and eosin (H&E) staining can make it difficult to distinguish malignant tumor cells from normal cells. Immunohistochemical staining with EpCAM antibodies helps identify remaining tumor cells and allows for easier visualization of perineural or perivascular invasion. The study concludes that the implementation of EpCAM immunostaining has increased confidence in tumor clearance during the treatment of aggressive BCCs. However, further studies are needed to determine its generalizability and benefits in routine MMS diagnoses. [Extracted from the article]

Background Basosquamous carcinoma ( BSC) and metatypical basal cell carcinoma ( MBCC) are uncommon tumors poorly defined in the literature. Available studies suggest these tumors carry a greater risk of recurrence and metastases than basal cell carcinomas ( BCCs) and, in some studies, squamous cell carcinomas. Formal treatment recommendations are not fully established. Objective To analyze BSC and MBCC separately, evaluate whether they are distinct tumor subtypes, and analyze Mohs micrographic surgery ( MMS) efficacy for BSC and MBCC. Methods Retrospective review of medical records and histologic specimens was conducted for 293 patients with 303 biopsy-proven BSCs or MBCCs treated with MMS between 1996 and 2004. In total, 32 BSCs and 128 MBCCs were identified. Surgical and follow-up data were analyzed. Results Kaplan-Meier estimates of recurrence-free survival after MMS were 100% at one year for both tumor subtypes and were 100% for BSC and 93.8% for MBCC at 5 years. Initial mean sizes were 1.5 cm for BSC and 1.3 cm for MBCC. Approximately 7% represented recurrent tumors at surgery. Of six patients with recurrences, none had known metastatic disease. Limitations Limitations include retrospective design, analysis of only head and neck sites, and small sample sizes. Conclusion BSC and MBCC showed no significant distinguishing characteristics to separate them into two BCC subtypes. Reported recurrence rates for BSC and MBCC are 12-45% with wide local excision; estimated recurrence rates are 4.1% with MMS. Our study showed recurrence-free survival of 95.1% at five years. Hence, MMS is effective in treating these BCC subtypes. [ABSTRACT FROM AUTHOR]

Background Verrucous carcinoma (VC) of the anogenital area is an uncommon variant of squamous cell carcinoma (SCC). Its treatment is not standardized, but surgical excision must be performed if possible. The traditional approach does not distinguish between conventional SCC and VC, despite the extremely low metastatic potential of VC. Accordingly, most patients reported in the literature have been treated with radical surgery, including regional lymphadenectomy. Methods We report two cases in order to describe the oncologic, functional, and esthetic results achieved by Mohs micrographic surgery (MMS) in the treatment of this disease. Results Good functional and esthetic results were achieved in both patients. No local or nodal relapses were detected during the respective 12- and 27-month follow-ups. Conclusions Early recognition of VC and the proper evaluation of deep biopsies will avoid misdiagnosis as SCC and may prevent the occurrence of unnecessary disfiguring interventions. The MMS technique may be considered as a surgical approach in genitoanal VC, although further research is required to confirm this. [ABSTRACT FROM AUTHOR]

Background: Reports regarding squamous cell carcinoma of the nail unit (SCCnu) are rare in Asia. Objectives: To investigate the features of SCCnu in the Asian population. Method: We performed a retrospective review of patients diagnosed with SCCnu at our institution between 2012 and 2017. Results: Nineteen cases were included. Thirteen patients were male (68.4%). The fingers were most frequently affected (73.7%). Mean delay to diagnosis was 62.4 months. Misdiagnosis rate was high (78.9%). Frequent clinical features were subungual tumor, subungual hyperkeratosis, nail dystrophy, ulcer, and nail loss. The majority of cases were invasive SCC in 15 cases (78.9%), while SCC in situ was found in four cases (21.1%). Local recurrence was detected in two cases (10.5%) following surgical resection. However, distant metastasis was not reported. Conclusion: This study provides data of 19 SCCnu cases in Asia. Clinical characteristics of SCCnu in this study were similar to those of reports from Western countries. However, we found a higher frequency of more invasive cases and longer delay to diagnosis in our study; this advocates the need for greater attention on nail disorders among healthcare providers, particularly in Asia. [ABSTRACT FROM AUTHOR]

Mohs micrographic surgery (MMS) is a technique designed to achieve complete margin control in the removal of cutaneous neoplasms while requiring minimal tissue excision. With the marker tip's long axis parallel to the surgical site, the surgeon can quickly and uniformly color the tumor-positive tissue targeted for excision. In contrast to methylene blue and gentian violet, the surgical marker is sterile and disposable, allowing it to be used freely after the surgeon has scrubbed and draped. [Extracted from the article]

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma, which has been reported in pregnancy. This case series reports the clinical and histopathological findings of DFSP in pregnancy. Methods: Eighteen cases of DFSP, including six unreported cases and 12 cases from the literature, were identified. Age, anatomic location, tumor size, changes in tumor characteristics during pregnancy, histopathological features, and treatment were recorded. Follow‐up data, when available, were noted. Results: The average age of the cohort was 30.6 years (range 19–38). Ten tumors (55.6%) were located on the trunk, four (22.2%) on the head and neck, three (16.7%) on the extremities, and one (5.6%) in the genitalia. Most tumors demonstrated features of conventional DFSP (12/18, 66.7%), while the remaining were identified as DFSP with fibrosarcomatous (FS) change (3/18, 16.7%), atrophic DFSP (2/18, 11.1%), and myxoid DFSP (1/18, 5.6%). Treatment was reported in 17 cases, at least nine of which were treated postpartum. Ten patients were treated with excision, while seven underwent Mohs micrographic surgery. Three patients recurred on follow‐up, one with local recurrence and two with distant metastasis. Conclusions: DFSP can undergo enlargement or change in size or color in pregnancy, possibly mediated by hormones. While the majority of cases in this series represented conventional DFSP, unusual clinical and histopathological variants were also present. Treatment in most cases can be safely delayed until after delivery, but recurrent or very large tumors may require treatment prepartum. Close monitoring for recurrence or metastasis is advised. [ABSTRACT FROM AUTHOR]

The article discusses the potential applications of the Apple Vision Pro (AVP) mixed reality headset in dermatology, particularly in Mohs micrographic surgery (MMS), cosmetic dermatology, and medical dermatology. AVP's mixed reality capabilities can enhance surgical precision, procedural guidance, patient engagement, and streamline office visits. The integration of AVP into clinical workflows may require education and focus groups to gather insights on perception and usage. Overall, AVP shows promise in improving dermatologic practice through innovative technologies and applications. [Extracted from the article]

The article presents a case study of a 68-year-old woman with a pruritic, pink plaque on the right fifth digit. She had a history of breast cancer, renal cell cancer, follicular cell lymphoma, and non-melanoma skin cancer. A papule was also noted beneath the nail plate on the left thumb. She was diagnosed with basal cell carcinoma (BCC) on two nail units on examining with biopsy. She was then treated with Mohs micrographic surgery (MMS) followed by granulation.

Background Aggressive digital papillary adenocarcinoma ( ADPA) is a rare adenocarcinoma of the sweat glands. Aims We wish to report the treatment of two cases of ADPA with Mohs micrographic surgery and review the presentation, management, and prognosis of this rare malignancy. Materials & Methods Cases of ADPA were identified from recent surgery logs. Demographic, tumor, and treatment characteristics were extracted. A PubMed database search for English language full-text articles of aggressive digital papillary adenocarcinoma was performed, and relevant articles were summarized. Results Two cases of ADPA were identified. A 53-year-old man presented with ADPA on his right third fingernail, and a 65-year-old man presented with ADPA on his right thumb. Both patients underwent Mohs micrographic surgery and negative sentinel lymph node biopsy, remaining recurrence free at 34 and 9 months, respectively. Discussion ADPA frequently presents as a solitary mass on the digit. Treatment of ADPA with local excision or amputation has historically been fraught with high recurrence rates. Regional lymph node spread and distant metastasis have been reported. Mohs micrographic surgery may be an alternative treatment for ADPA. Conclusion Mohs micrographic surgery is a viable option for ADPA and warrants further exploration. Long-term follow-up is important, and additional studies will need to identify the role of sentinel lymph node biopsy. [ABSTRACT FROM AUTHOR]

Background Merkel cell carcinoma is a rare and often lethal cutaneous neuroendocrine malignancy with a tendency for early and frequent locoregional and distant metastasis and relapses. It is a tumor of the elderly and immunosuppressed, which most often appears on sun-exposed areas of the body. There is growing interest in characterization of the disease and the best approach to its management. Despite the lack of prospective randomized clinical trials, treatment is evolving. Objective To provide an updated review of the most current and relevant data concerning the surgical (± radiological) management of Merkel cell carcinoma, including the role of Mohs micrographic surgery. Methods Using relevant Me SH terms, we performed a review of the literature on the above subjects from 1981 to 2011. Results and conclusion For primary tumors without evidence of organ metastases, surgical excision should be the primary therapy. Owing to the high rate of local metastases, a safety margin of at least 2 cm should be considered. In situations where small, localized tumors and/or special locations necessitate a smaller safety margin, compensation by complete histological examination of the excision margins and perhaps adjuvant radiation therapy should be undertaken. The literature states that benefits of Mohs micrographic surgery (over wide local excision) include tissue conservation and identification of tumors that may require extremely wide excision margins. The majority of data to date supports the use of Mohs surgery in the treatment of Merkel cell carcinoma. [ABSTRACT FROM AUTHOR]

Background: Given the rarity of dermatofibrosarcoma protuberans (DFSP) of the head and neck, the incidence and prognosis specific to this region are poorly defined. The purpose of this study was to determine epidemiology, clinicopathological characteristics, and prognostic factors of patients with DFSP of the head and neck region, using the Surveillance, Epidemiology, and End Results (SEER) database. Methods: A cohort analysis was performed for primary head and neck DFSP reported to the SEER database between 2000 and 2018. Overall survival was determined using Kaplan–Meier analysis while Cox regression modeling was used to examine predictive factors. Results: A total of 681 cases were reported to the SEER database between 2000 and 2018. Incidence rates decreased over time. Overall survival was 94%, and disease‐specific survival was 99% at 5 years. Cases of head and neck DFSP were found to occur more frequently in males. There was no difference in incidence rates between White patients and Black patients. Age ≥ 60 years old, tumor size, and living location were the most significant predictors of overall survival. Conclusions: This analysis of DFSP of the head and neck demonstrates a downward trend in incidence, higher age‐standardized incidence in males, and similar race‐based incidences, which differs from data reported on DFSP of other anatomic locations. [ABSTRACT FROM AUTHOR]

AR devices start to be used in the operating room, and the Israeli start-up Augmedics® has developed an augmented reality headset for spine surgeons with a technology that overlays a 3D model of the CT scan on the spine really close to the surgical field allowing the surgeon to focus on the field without the need to look at screens.[2] In Mohs micrographic surgery (MMS), in Spain and other European countries, surgery is performed as teamwork (surgeon, pathologist, and technician). The Mohs surgeon performs the stages while a trained pathologist reads them and informs the surgeon aided by drawings, telephone, text, or instant message applications. [Extracted from the article]

Background: Patients with hypertrophic lichen planus (HLP) and squamous cell carcinoma (SCC) diagnoses present clinicians with diagnostic and disease management challenges. Objective: To better define the clinical and treatment outcomes of patients with concomitant diagnoses of HLP and SCC. Methods and Materials: A retrospective review was performed from January 1, 2008, to July 31, 2015, at Mayo Clinic. Patients with a histologic diagnosis of HLP and SCC were included. Patient demographics, associated comorbidities, histopathologic characteristics, treatment, and outcomes were evaluated. Results: Thirty‐three patients were identified; 79% were female, and mostly the lower extremities were involved. Most of the SCCs were well‐differentiated and in situ with the majority treated with destruction or excision. There were no cases of local recurrence, metastasis, or disease‐specific death during the follow‐up period (mean 55.8 months). Conclusion: Patients with diagnoses of both HLP and SCC appear to be a distinct population that is predominantly female with lesion predilection for the lower extremities. However, regardless of treatment modality or tumor size, there were no adverse outcomes. An initial trial of more conservative treatment measures with close follow‐up may be reasonable with biopsy of lesions unresponsive to conventional treatment. [ABSTRACT FROM AUTHOR]