Foreword

The incidence of skin cancers is rising annually. Non-melanoma skin cancers (NMSC) constitute a large majority of all skin cancers, with more than 3,500,00 new cases reported in the United States per year. There has been a noticeable rise in NMSCs among the immunosuppressed population such as transplant patients, HIV/AIDS patients etc.

The technique of Mohs micrographic surgery was invented by Frederic E. Mohs while he was working as a cancer research assistant during his medical school in the early 1930s. His observation that the microscopic details of the tissue were retained upon an intratumoral injection of 20% zinc chloride, led to the genesis of the idea of excising cancer under microscopic control.

Later in 1953, Dr. Mohs demonstrated the fresh tissue technique while performing Mohs on a basal cell carcinoma (BCC) on the eyelid. A 5-year cure rate of 100% using the fresh-tissue technique to excise eyelid carcinomas was reported in 1969. Wide acceptance of the fresh-tissue technique increased substantially and has become a very popular method in the United States. It is considered the technique of choice and standard of care for NMSCs with certain criteria due to the fact that it provides the highest cure rate and maximal tissue conservation with smallest possible defect. Mohs Surgery has been used for NMSCs, some forms of melanoma and other rare cutaneous tumors.

Mohs Micrographic Surgery has become more and more popular dramatically. Fellowships have been set up for teaching Mohs Micrographic Surgery, and recently these techniques under the auspices of American College of Graduate Medical Education (ACGME) has been renamed Procedural Dermatology. The main components of Procedural Dermatology aim at developing proficiency and skill in Mohs Surgery.

Mohs Micrographic Surgery by Keyvan Nouri is the most up to date, comprehensive and easy to comprehend textbook in the area of Mohs surgery. It includes sections on Fundamentals of Mohs Micrographic Surgery, Laboratory Processing, Mohs Micrographic Surgery by tumor and site, Pitfalls of Mohs Micrographic Surgery, Reconstructive and Adjuvant Techniques, Training and Certification in Mohs Micrographic Surgery and Patient Safety and Medicolegal Issues. The authors of the book are some of the most reputable surgeons in the field. The book also includes a section on International Perspective of Mohs Micrographic Surgery which highlights the Mohs surgical practices in various parts of the world.

To sum, I strongly recommend the textbook Mohs Micrographic Surgery by Dr. Keyvan Nouri and published by Springer as one of the best textbooks in this area. I congratulate Dr. Nouri and all the authors and publishers for putting together such a comprehensive and illustrious textbook.

Perry Robins Professor Emeritus of Mohs Micrographic Surgery of NYU medical center President of Skin Cancer Foundation

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Preface

Mohs micrographic surgery has revolutionized the practice of cutaneous oncology with its method of accurate, staged intraoperative histological analysis. The indications for the procedure and technique have been drastically expanded, yet the underlying principles put forth by Dr. Frederic Mohs approximately prior to 70 years remain largely unchanged. The technique evolved from the fixed tissue method utilizing zinc chloride for chemosurgery to the present day fresh frozen tissue technique. With the advent of the fresh frozen tissue technique, the ability to conduct extensive reconstructive surgery became available to dermatologic surgeons. As a result, dermatologists began performing extensive procedures that had previously been carried out by other specialties. The dermatologic surgeons then began forming organizations that were dedicated to advances in the field of dermatologic surgery and cutaneous oncology. Now immunostains are beginning to be implemented, which have expanded the utility of Mohs surgery to treat certain forms of melanomas and other rare or unusual tumors. Nearly 3.5 million new cases of skin cancer are diagnosed per annum, of which a large percentage will be treated by Mohs micrographic surgery. The indications for Mohs micrographic surgery are moving beyond the traditional basal cell and squamous cell carcinoma to include: dermatofibrosarcoma protuberans, microcystic adnexal carcinoma, atypical fibroxanthoma, sebaceous carcinoma, extramammary Paget’s disease, and Merkel cell carcinoma.

This textbook attempts to explore Mohs micrographic surgery in all of its realms and presents a thorough representation of the surgical practice. Each chapter is easy to read with summary boxes to emphasize the major points. The chapters are written by well-known experts in their respective fields. We have included an international section to highlight the progression of Mohs surgery throughout the world. As we have transgressed into the modern era of the practice of Mohs surgery, the medicolegal issues along with the relevant ethical and patient safety considerations are also explored.

Overall, the reader should enjoy an up-to-date, reliable source of information discussing the important aspects of Mohs surgery. The reader will obtain a detailed understanding of this surgical practice, which will undoubtedly improve patient care.

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