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

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Daniel Bernstein
Sara Giddings
Hooman Khorasani


Mohs micrographic surgery, peripheral margin control, morpheaform, BCC, SCC, multidisciplinary


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.


1) Manstein ME, Manstein CH, Smith R. How accurate is frozen section for skin cancers? Ann Plast Surg. 2003 Jun;50(6):607-9.
2) Mahoney MH, Joseph M, Temple CL. The perimeter technique for lentigo maligna: an alternative to Mohs micrographic surgery. J Surg Oncol. 2005 Aug 1;91(2):120-5.
3) Patel AN, Perkins W, Leach IH, Varma S. Johnson square procedure for lentigo maligna and lentigo maligna melanoma. Clin Exp Dermatol. 2014 Jul;39(5):570-6.
4) Gaudy-Marqueste C, Perchenet AS, Taséi AM, Madjlessi N, Magalon G, Richard MA, Grob JJ. The "spaghetti technique": an alternative to Mohs surgery or staged surgery for problematic lentiginous melanoma (lentigo maligna and acral lentiginous melanoma). J Am Acad Dermatol. 2011 Jan;64(1):113-8.
5) Seth R, Revenaugh PC, Vidimos AT, Scharpf J, Somani AK, Fritz MA. Simultaneous intraoperative Mohs clearance and reconstruction for advanced cutaneous malignancies. Arch Facial Plast Surg. 2011 Nov-Dec;13(6):404-10.
6) Vance KK, Pytynia KB, Antony AK, Krunic AL. Mohs moat: peripheral cutaneous margin clearance in a collaborative approach for aggressive and deeply invasive basal cell carcinoma. Australas J Dermatol. 2014 Aug;55(3):198-200.
7) Ducic Y, Marra DE, Kennard C. Initial Mohs surgery followed by planned surgical resection of massive cutaneous carcinomas of the head and neck. Laryngoscope. 2009 Apr;119(4):774-7.
8) Buck DW 2nd1, Kim JY, Alam M, Rawlani V, Johnson S, Connor CM, Dumanian GA, Wayne JD. Multidisciplinary approach to the management of dermatofibrosarcoma protuberans. J Am Acad Dermatol. 2012 Nov;67(5):861-6.

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