Simultaneous Intraoperative Mohs Clearance and Reconstruction for Advanced Cutaneous Malignancies

Background Improved control of cutaneous malignancies using Mohs micrographic pathologic clearance has been well established. However, surgical margin control of advanced and complex cutaneous tumors of the head and neck is commonly performed by far less reliable frozen section margin analysis. Objective To describe a routine and ideal collaboration between dermatologic surgery and facial plastic surgery/head and neck surgery in which the Mohs micrographic method is used intraoperatively to achieve marginal clearance during resection and reconstruction. Methods A single-institution retrospective analysis was performed of patients who underwent intraoperative Mohs micrographic surgery. Intraoperative margins (peripheral and deep) of tissue specimens were analyzed by the Mohs surgeon. Results Twenty-six patients underwent large cutaneous tumor resection using intraoperative Mohs micrographic surgery. Most lesions were basal (48%) or squamous (34%) cell carcinoma. A mean (SD) of 2.1 (0.98) resection layers were required before negative margins were achieved. Conclusions We demonstrate the intraoperative technique and utility of Mohs micrographic analysis via an efficient collaborative effort. Well established for accuracy greater than intraoperative frozen section margin analysis, intraoperative Mohs micrographic surgery provides an optimal method of intraoperative margin assessment of cutaneous malignancies.