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Issues in Dermatology
October 1999

Mohs Micrographic Surgery: A Pathologist's View

Arch Dermatol. 1999;135(10):1171-1173. doi:10.1001/archderm.135.10.1171

I would like to begin this article by trying to determine what exactly it is that sets Mohs micrographic surgery (MMS) apart from any other surgical procedure carried out for the expressed purpose of removing a neoplasm, whether primary or recurrent at the local site. Because most practitioners of MMS now admit freely that the distinctiveness of MMS is not1 the type of procedure (such as the use of zinc chloride or any other form of chemosurgery),2 the type of equipment used (as implied by the reassuring statement that "most Mohs' surgeons can effectively operate with standard surgical instruments"),3 or the type of clinical indication (such as recurrent basal cell carcinoma), its claim to superiority must derive from the notion that MMS represents a "microscopically controlled" brand of surgery. That idea has been advanced by Mohs4 himself, who stated that "the unique and important feature of chemosurgery [is] the complete microscopic control of excision rather than the in situ chemical fixations.'' This concept is reflected in the currently preferred terminology for the technique, ie, micrographic surgery, which originates from micro, referring to the microscope, and graphic, referring to a map or graph of the lesion made for purposes of orientation at the time the frozen section is performed.5

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