INTRODUCTION

When Dr. Frederick Mohs developed his technique to improve the examination of surgical margins, he initially applied it for treatment of cutaneous neoplasms. Although basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) made up the bulk of these tumors, melanomas were soon added to the list, as were other neoplasms and even infectious processes.

The technique has since been utilized to ensure complete examination of surgical margins of an ever-expanding list of proliferations. Some examples include: BCC, SCC, melanoma, melanoma in situ (lentigo maligna), merkel cell carcinoma, verrucous carcinoma, sebaceous carcinoma, Bowen's disease (squamous cell carcinoma in situ), microcystic adnexal carcinoma, dermatofibrosarcoma protuberans, extramammary Paget's disease, malignant fibrous histiocytoma, leiomyosarcoma, angiosarcoma, and benign adnexal tumors.

The challenges of utilizing the Mohs techniques for tumors other than those commonly treated surgically, such as basal or SCCs, include the larger size of some of these tumors and the bland cytology that can resemble scar tissue or normal structures, as well as the need to use additional techniques or laboratory studies (e.g., immunohistochemistry stains).

This section does not represent an exhaustive list of applications of the Mohs technique to ensure complete marginal clearance of every tumor for which it has been utilized, but rather examines representative lesions and the techniques that can be used.