September/October 2014
Volume 12 • Issue 5
Core curriculum Virendra N. Sehgal, MD, Section Editor
Mohs Micrographic Surgery: History, Technique, and Advancements Tulsie Narendra Patel, BS; Shailee Bipin Patel, BS; Katlein Franca, MD, MSc; Anna Haydee Chacon, MD; Keyvan Nouri, MD
Mohs micrographic surgery is an excision technique that has been widely adapted as the recommended treatment for basal and squamous cell carcinomas and other skin cancers. It was developed by Frederic E. Mohs in the 1930s and has since advanced in its methods and applications. Mohs developed the practice in the process of determining a method to treat various neoplasms. Mohs micrographic surgery is a modality that involves serial excision of a tumor followed by microscopic evaluation of the tissue. It is a complicated surgical technique that involves scrupulous training and constant adaptation. It has greatly expanded since its inception to include new imaging techniques such as immunohistochemistry and confocal mosaicing microscopy. Further advancements include its application to other medical specialties, such as otolaryngology. This technique began as a revolutionary practice but has since become the standard treatment for a variety of skin cancers. (SKINmed. 2014;12:289–292)
M
ohs micrographic surgery is a surgical technique that was pioneered and founded by Frederic E. Mohs in the early 1930s.1,2 Mohs established this excision technique while working alongside Professor Michael F. Guyer at the University of Wisconsin.1 Mohs and Guyer studied the fixative properties of various substances that were injected into neoplasms.1 This idea was inspired by the use of chemicals to treat tumors as illustrated by the Egyptians with arsenic and by Sir Humphrey Davy using zinc chloride.3 Various chemical combinations were applied and studied.1 Eventually, Mohs found that zinc chloride was especially potent, as it allowed for a tumor to be sequentially excised after the fixative process was complete.1,4 The excised tissue was then examined under a microscope to ensure that the entire tumor had been removed.2,4 The technique of using chemicals in order to remove the tumor was coined “chemosurgery.”4 Mohs, a general surgeon, wanted to introduce a new practice into the field of general surgery for the treatment of tumors that were previously considered untreatable.1,3 Through his efforts, Mohs was able to illustrate an incredibly high cure rate, >97%, associated with chemosurgery.1,3 He was able to cure patients with late-stage disease who were previously deemed incurable.3
As Mohs surgery became better known, Mohs created the American College of Chemosurgery in 1968.3 Due to the precarious nature of tumors of the skin, it was important to Mohs that all who practiced chemosurgery be methodically trained.1 The American College of Chemosurgery therefore created a specific fellowship program under which dermatologists could study the precise art of Mohs surgery.1 This focused training program has been vital towards the widespread recognition of this practice as a viable option for the treatment of skin cancers by all medical specialties.1 The first Mohs surgery fellowship was initiated at New York University by a dermatologist, Perry Robbins.5 The program began as a 1-year fellowship in which fellows were trained in all aspects of the technique including surgery, dermatopathology, and wound care.5 Today, these programs range between 1 and 2 years of training and are accredited by the American College of Mohs Surgery (ACMS) and the Accreditation Council for Graduate Medical Education (ACGME).6 Although training under the ACMS and the ACGME varies slightly, both require that their fellows treat a variety of cases and at least 500 Mohs cases per year.6
From the Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL Address for Correspondence: Tulsie Narendra Patel, BS, University of Miami Miller School of Medicine, 1600 NW 10th Avenue #1140, Miami, FL 33136 • E-mail: tnpatel@med.miami.edu
SKINmed. 2014;12:289–292
289
© 2014 Pulse Marketing & Communications, LLC