Who should have Mohs micrographic surgery

Purpose of review To review the indications for Mohs micrographic surgery in skin cancer particularly with relationship to tumours of the head and neck and any recent developments which may influence those indications in the near future. Recent findings There is increasing evidence to support the use of Mohs micrographic surgery in the treatment of recurrent and primary basal cell carcinoma and in squamous cell carcinoma, particularly when there is evidence of perineural invasion. Mohs micrographic surgery is particularly effective in the treatment of dermatofibosarcoma protuberans, especially in the high-risk head and neck area in which wide local excision may not be possible. Developments in freshly excised tissue imaging by confocal fluorescence microscopy and/or Raman spectroscopy may further refine the technique of Mohs micrographic surgery. Developments in immunohistochemistry with rapid staining of frozen sections may make Mohs micrographic surgery for lentigo maligna and melanoma in situ more feasible in the future, which would be an advantage in the head and neck. Summary The evidence base for the use of Mohs micrographic surgery for a wide range of cutaneous tumours is growing and the technique continues to develop. Close collaboration between Mohs micrographic surgeons, specialist surgical oncologists and reconstructive surgeons will provide the highest quality care for our patients with some of the most challenging cutaneous tumours.