Mohs Micrographic Surgery Peripheral Margin Control Prior to En Bloc Tumor Resection: A Report of Three Cases

Abstract

Background: Mohs micrographic surgery (MMS) is an important part of non-melanoma skin cancer (NMSC) management but may even be useful for tumors that cannot be cleared in an office setting.  There are sparse reports of MMS for peripheral margin control in the dermatology literature but various techniques have been reported.

Case 1: 58-year-old male with morpheaform basal cell carcinoma of the left midface treated with MMS peripheral margin control followed by facial plastic surgery central tumor extirpation and defect repair.

Case 2: 56-year-old female with recurrent morpheaform BCC of the scalp treated with MMS peripheral margin control followed by facial plastic surgery central tumor extirpation and defect repair.

Case 3: 73-year-old male with multiply recurrent SCC of the right lower extremity treated with MMS peripheral margin control followed by above the knee amputation.

Conclusions:  MMS peripheral margin control followed by central tumor extirpation and defect reconstruction at a later date in the operating room is an option for deeply invasive, large and aggressive NMSC.  Benefits include decreased time under general anesthesia and superior rates of tumor clearance.  In the interim, the peripheral defect between the central tumor and healthy outer tissue can be sutured closed to decrease patient morbidity.