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November 1992

Mohs Micrographic Surgery and the Practitioner

Author Affiliations

3708 Jefferson Suite 103 Austin, TX 78731

Arch Dermatol. 1992;128(11):1545. doi:10.1001/archderm.1992.01680210125021

To the Editor.—  Dr Ronald Rapini's editorial1 on Mohs surgery is his second2 thoughtful article on the subject in several years. However, many of his arguments are incorrect, and they certainly do not support the conclusion that there is anything uncertain in the definition of Mohs micrographic surgery (MMS).Foremost, I must take issue with his discussion of the bevel used in MMS. A 90° bevel, as he advocates, precludes in continuity evaluation of margins. Axiomatic to MMS is the removal of a continuous layer of tissue (no buttonholes and complete epidermal edge) to irradicate a tumor that is continuous (no skip areas). Separating the histologic evaluation of "the edge" from "the base" violates this continuity. The geometry of such a technique would create a pathway for tumor to escape detection. What a leap of faith he asks of us to accept this approach based on his experience

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