To the Editor In the thoughtful study by Schell et al,1 the authors predicate their conclusions on the assumption that all surgeons view the initial lesion with equal ability. This is not the case. In their article, the lighting and magnification for determining the initial size of the lesion is not described. When superior lighting and loop magnification are used at the time of surgery, the true extent of the cancer can be better visualized, making one question many findings in this study, including the conclusion that “traditional” surgical excision would incompletely excise 14.2% to 27.6% of lesions. Furthermore, I am disappointed that the authors included in their article “before and after” pictures of defects that do not support their findings and further the misconception that facial nonmelanoma skin carcinomas are difficult and best treated by Mohs micrographic surgery.
Alexiou M. Mohs Needs a Better Look. JAMA Facial Plast Surg. 2013;15(6):461. doi:10.1001/jamafacial.2013.2181