Reasons For Varied Results of Moh's Surgery

Moh's surgery is considered as a highly effective methods used by dermatologists in determining skin cancer. As cited by numerous studies, the cure rate with Mohs surgery averages from 97% and 99.8% for primary basal cell carcinoma, the most common type of skin cancer. However, in two different studies, reports show that the cure rate for primary basal cell cancer can go to as low as 95% and 96% while recurrent basal cell cancer has a lower cure rate with Mohs surgery, falling somewhere in the range of 94%.

Moh's surgery has also been used in the removal of melanoma-in-situ, with cure rate going as high as 77% to 98%. According to ontario dermatologists, another study of melanoma-in-situ revealed Mohs cure rate of 95% for frozen section Mohs, and 98 to 99% for fixed tissue Mohs method. These results gave rise to the popularity of Moh's surgery in the removal of skin cancer. There are, however, questions as to why the success rate of Moh's surgery could only go as high as 99% and not 100%. Also,the varied results have gained several criticisms from other people.
according to ontario dermatologists,

Reasons for Moh's Surgery's varied results

There are several reasons as to why the results of Moh's surgery vary. These include:

* Although new, the modern use of frozen section method does not give the added margin of safety of the cytotoxic Mohs paste, originally used by Dr. Mohs.

* Vigorous scrubbing, poorly controlled initial curettage, poor tissue health, technician's error, and surgeon's error can introduce areas missing epithelial margin.

* The difficulty in differentiating between a small island of basal cell carcinoma and a hair follicle structure can sometimes lead to misreading of the pathology slide.

* Compression artifact, freezing artifact, cautery artifact, tissue folds, crush artifact from forceps, relaxing incision artifact, cartilage dropping out, fat compression, poor staining, dropping of tumor, etc.

* In some cases, the tumor is difficult to distinguish in heavy inflammatory infiltrate.

* Sometimes perineural spread, and benign changes simulate perineural spread.

* Depending on the location, it can be difficult to cut and process the anatomical area.

* Skin cancer may recur with multiple islands of recurrence.

* Recurrence are sometimes not reported or underreported.

* Poor training of the surgeon/pathologist/histotechnologist.

Popularity in Cosmetic surgery

Cosmetic appearance for Mohs surgery is very good, if combined with good reconstructive surgical skills. Some Mohs surgeons utilize plastic or work with reconstructive surgeons for the closure, while some Mohs surgeons perform the reconstruction by themselves. According to ontario dermatologists, there are dermatologists who are great reconstructive surgeons, and plastic surgeons who are poor reconstructive surgeons.