Mohs Micrographic Surgery: A Narrative Review of Current Practices, Emerging Trends, and Case-Based Insights.

Abstract

Mohs micrographic surgery (MMS) is a method used to treat skin cancers. It ensures a complete microscopic examination of the tumor margins with the conservation of surrounding tissue, leading to high cure rates and favorable cosmetic outcomes. In each Mohs stage, the excised specimen is frozen and sectioned horizontally, and its margins are evaluated for the presence of malignant cells. A variety of staining methods can be employed, including immunohistochemical. The process is repeated until all margins are negative. The most common indications for MMS are non-melanoma skin cancers, but it is increasingly utilized for other skin lesions, such as melanoma, lentigo maligna, and dermatofibrosarcoma protuberans. A growing body of evidence indicates significantly higher cure rates and a lower risk of local recurrence associated with MMS compared to other surgical modalities. Numerous modifications of the Mohs surgical technique have been developed to enhance the accuracy of margin control and to tackle specific challenges associated with various tumor types. Such alternative approaches include the "spaghetti technique," the "slow Mohs" technique, and other variations such as the Munich method, the square method, the muffin technique, or the perimeter technique. Complications are rare and include infections, bleeding, or impaired wound healing. The increasing popularity of noninvasive imaging, digital pathology, and artificial intelligence models will likely enhance the efficiency of MMS in the future. Machine learning can predict diagnoses, recommend treatment options, predict responses to treatment and potential drug interactions, or help plan surgical procedures, enabling dermatologists to tailor therapies to individual patient characteristics. In addition to presenting the latest trends in Mohs micrographic surgery, this article includes a selection of clinical cases, with an overview of the treatment protocols followed by our institution, as well as data on recurrences based on our clinical experience.