Conservative thickness layers in Mohs micrographic surgery

• Published in: International journal of dermatology Vol. 57; no. 9; pp. 1128 - 1134
• Main Authors: Tolkachjov, Stanislav N., Cappel, Jonathan A., Bryant, Elizabeth A., Harmon, Christopher B.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.09.2018
• Subjects: Adult; Aged; Carcinoma, Basal Cell - surgery; Carcinoma, Squamous Cell - surgery; Complications; Cytotoxicity; Demographics; Demography; Female; Granulation; Humans; Lymphocytes T; Maintenance; Male; Middle Aged; Mohs Surgery - adverse effects; Mohs Surgery - methods; Nose; Patient Selection; Retrospective Studies; Scalp; Skin Neoplasms - surgery; Surgery; Thickness; Tumors
• ISSN: 0011-9059; 1365-4632
• DOI: 10.1111/ijd.14043

Background Mohs micrographic surgery (MMS) is used to treat cutaneous malignancies in locations to maximize tissue sparing. The authors’ aim is to demonstrate the utility of conservative thickness layers (CTL) in MMS and review patient and tumor characteristics and the potential anatomic locations where this technique may be most useful. Methods We performed a retrospective chart review of patients with tumors treated with CTL in MMS of 339 tumors, recording patient demographics, tumor characteristics, MMS stages for clearance, repairs, complications, and follow‐up. Results A total of 339 tumors were treated with CTL. The most common site was the leg (28.6%), with 77.4% of these being female. The next most common sites were nose (24.5%), scalp (13.9%), and back (11.5%). Most tumors were cleared with one layer (269), but some required two layers (42), three layers (11), and four layers (1). A total of 264 tumors were left to granulate, while 75 of the nasal tumors had immediate dermabrasion. Conclusion In the properly selected patient and anatomic location, CTL taken as the first stage in MMS can be an effective and time‐saving technique, leaving wounds in optimal condition for granulation with a low complication rate. Tissue sparing may allow for more reconstructive options.