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November 1992

The Subtleties of Mohs Surgery

Author Affiliations

Department of Medicine (Dermatology) James H. Quillen College of Medicine East Tennessee State University Johnson City, TN 37604

Arch Dermatol. 1992;128(11):1545-1546. doi:10.1001/archderm.1992.01680210125022

To the Editor.—  I read Rapini's1 editorial in the May 1992 issue of the Archives and found some of his suggestions concerning modifications of the Mohs technique worrisome. There are subtleties of Mohs surgery that are not readily apparent to observers that were not discussed and that bear directly on the enormous success of this procedure.Mohs surgeons insist that tissue be excised obliquely and sectioned horizontally with lateral and deep margins in the same plane and that all slides be reviewed by the surgeon. The purpose of these rigid guidelines is to enable the surgeon examining the slides to develop a three-dimensional mental image of the tumor. It is this mental image that the surgeon carries back to the operating room that gives Mohs surgery uniformly high cure rates no matter how complicated the case. In difficult tumors, it is not sufficient for the surgeon to know only

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