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Acknowledgements

I sincerely thank all the authors of this textbook. These individuals are world-renowned in their respective specialties and without their time and energy, writing this book would have not been possible. These individuals have made this a comprehensive, up-to-date, and reliable source on Mohs micrographic surgery. I truly appreciate their hard work and thank them for their contributions.

Throughout my career, my family has always supported my many endeavors. I cannot thank them enough for their kind encouragement and love.

I would like to give a special thanks to Dr. Lawrence A. Schachner, Chairman of the Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine. He has been my mentor throughout my professional career. His guidance and role as an advisor over the years have influenced my efforts.

I am grateful to Dr. William H. Eaglestein, former Chairman of Dermatology at the University of Miami School of Medicine for helping and guiding me since my start in dermatology. I appreciate all of his guidance and support.

Thank you to Dr. Perry Robins, Dr. Robin Ashinoff, Dr. Vicki Levine, Dr. Seth Orlow, the late Dr. Irvin Freedberg, Dr. Hideko Kamino, and the entire faculty and staff at New York University School of Medicine Department of Dermatology. You have all created a wonderful learning and friendship experience during my surgery fellowship.

I would like to thank the faculty, dermatology residents, and staff of the Department of Dermatology and Cutaneous Surgery at the University of Miami Miller school of Medicine for their teaching, expertise, and friendship. I give special acknowledgements to the Mohs and Laser Center staff at the Sylvester Cancer Center for their hard work and support on a daily basis. I would also like to thank Maria D. Garcia, my administrative assistant, for her diligence and hard work and the rest of the Mohs staff, including Cathy Mamas, Juana Alonso, Tania Garcia, Veronica Sanchez, Liseth Velasquez, Tatania Carmouze and Lisbeth Napoles. Thank you for making my job a pleasure.

Thank you to Dr. Sonal Choudhary and Michael Patrick McLeod, my research fellows, as well as Dr. Yasser Al-qubaisy, my clinical fellow, for all their hard work and dedication to composing the book. Also, I would like to thank the medical student, Marilyn Zabielinski, and international fellow Dr. Katlein Franca, for their contributions.

I would also like to acknowledge the publishing staff Mr. Grant Weston, Ms. Linda Jacobs, Ms. Cate Rogers, and the entire Springer Publishing team for having done a superb job with the publication. It has been a pleasure working with them and this excellent project to compile the textbook.

Keyvan Nouri, M.D.

xi

Contents

1

An Introduction to Mohs Micrographic Surgery. . . . . . . . . . . . . . . . . .

1

 

Michael P. McLeod, Sonal Choudhary, and Keyvan Nouri

 

2

Indications for Mohs Micrographic Surgery . . . . . . . . . . . . . . . . . . . . .

5

 

Michael P. McLeod, Sonal Choudhary,

 

 

Yasser A. Alqubaisy, and Keyvan Nouri

 

3

Preoperative Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13

 

Sean R. Christensen and Sumaira Z. Aasi

 

4

Mohs Micrographic Surgery Operative Room Setup . . . . . . . . . . . . . .

35

 

Tobechi L. Ebede, Indira Singh, and Kishwer S. Nehal

 

5

Anesthetic Considerations: Local Versus Regional . . . . . . . . . . . . . . . .

53

 

Michael P. McLeod, Sonal Choudhary,

 

 

Yasser A. Alqubaisy, and Keyvan Nouri

 

6

Cutaneous Anatomy in Mohs Micrographic Surgery . . . . . . . . . . . . . .

61

 

Diana Bolotin and Murad Alam

 

7

Mohs Surgery: Fixed Tissue Technique . . . . . . . . . . . . . . . . . . . . . . . . .

77

 

Pearon G. Lang and Martin Braun III

 

8

Fresh Tissue Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

83

 

Michael P. McLeod, Katlein França, and Keyvan Nouri

 

9

Special Considerations for Mohs Micrographic

 

 

Surgery in Organ Transplant Recipients . . . . . . . . . . . . . . . . . . . . . . . .

87

 

Thomas Stasko and Daniel L. Christiansen

 

10

Mohs Micrographic Surgery in Ethnic Skin . . . . . . . . . . . . . . . . . . . . .

99

 

Brooke A. Jackson

 

11

Histopathology Laboratory Setup

 

 

and Necessary Instrumentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

105

 

Marilyn Zabielinski, Michael P. McLeod,

 

 

Sonal Choudhary, and Keyvan Nouri

 

12

Tissue Transport and Initial Processing

 

 

Cryostat Preparation of Slides. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

117

 

Michael P. McLeod, Sonal Choudhary,

 

 

Katlein França, and Keyvan Nouri

 

13

Histopathologic Interpretation of Mohs Slides . . . . . . . . . . . . . . . . . . .

123

 

Ashraf M. Hassanein and Hatem A. Hassanein

 

xiii

xiv

Contents

 

 

14 Tissue Specimen Documentation, Record Keeping,

and Sample Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Jeremy S. Youse, Robert H. Cook-Norris,

Richelle M. Knudson, and Randall K. Roenigk

15 Immunostains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Kapila V. Paghdal, Basil S. Cherpelis, and L. Frank Glass

16 Basal Cell Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 Michael P. McLeod, Sonal Choudhary,

Yasser A. Alqubaisy, and Keyvan Nouri

17 Squamous Cell Carcinoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 Nicole R. LeBoeuf, Lorraine M. Jennings,

Andrew E. Werchniak, and Chrysalyne D. Schmults

18 Mohs Micrographic Surgery

for the Treatment of Cutaneous Melanoma . . . . . . . . . . . . . . . . . . . . . . 211 Michael Campoli, Scott Freeman,

David G. Brodland, and John Zitelli

19 Dermatofibrosarcoma Protuberans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225

Novie Sroa and Nathalie C. Zeitouni

20 Microcystic Adnexal Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 Ioulios Palamaras and Richard J. Barlow

21 Atypical Fibroxanthoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 Richelle M. Knudson, Robert H. Cook-Norris,

Jeremy S. Youse, and Randall K. Roenigk

22 Extramammary Paget Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263 Bradley G. Merritt and David G. Brodland

23 Leiomyosarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279 Marc Rubenzik, Boonyapat Limthongkul, and Tatyana R. Humphreys

24 Merkel Cell Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287 Stephanie A. Diamantis and Victor J. Marks

25 Selected Sweat Gland Carcinomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295 Howard A. Oriba and Stephen N. Snow

26 Sebaceous Carcinoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315 Stephen N. Snow and Yaohui Gloria Xu

27 Mohs Micrographic Surgery for the Eyelid . . . . . . . . . . . . . . . . . . . . . . 331 Michael P. McLeod, Marilyn Zabielinski, Sonal Choudhary,

and Keyvan Nouri

28 Mohs Surgery for Periungual and Subungual Skin Cancer . . . . . . . . . 341 Steven Chow and Richard G. Bennett

29 Genitalia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353

Irene Vergilis-Kalner and Arash Kimyai-Asadi

30 Deep Structures of the Head and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . 363 Sarah G. Baker, Douglas M. Sidle, and Simon Yoo

Contents

 

xv

31

Complications of Mohs Micrographic Surgery . . . . . . . . . . . . . . . . . . .

383

 

Adam A. Ingraffea and Hugh M. Gloster Jr

 

32

Eyelid Reconstruction After Mohs Micrographic Surgery. . . . . . . . . .

395

 

Jennifer I. Hui and David T. Tse

 

33

Flaps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

405

 

Jessica M. Sheehan and Thomas E. Rohrer

 

34

Skin Grafting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

433

 

Susana M. Leal-Khouri and Sarah E. Grummer

 

35

Side to Side Closure After Mohs Surgery. . . . . . . . . . . . . . . . . . . . . . . .

443

 

Michael P. McLeod, Katlein França, Sonal Choudhary,

 

 

Yasser A. Alqubaisy, and Keyvan Nouri

 

36

Prosthetic Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

447

 

Glenn E. Turner and Jeffrey E. Rubenstein

 

37

Combination Therapy for the Nonsurgical Treatment

 

 

of Skin Cancers: Latest Research at Mount Sinai . . . . . . . . . . . . . . . .

465

 

Ellen S. Marmur and Hooman Khorasani

 

38

Training and Regulation in Mohs Surgery . . . . . . . . . . . . . . . . . . . . . . .

475

 

Suzanne M. Olbricht

 

39

Establishing a Mohs Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

479

 

Pearon G. Lang, Martin Braun III, Carlette M. Geddis,

 

 

and Jamie L. Benenhaley

 

40

International Perspective of Mohs

 

 

Micrographic Surgery: South America . . . . . . . . . . . . . . . . . . . . . . . . .

493

 

Luis Fernando F. Kopke and Gaston Nestor Galimberti

 

41

International Perspective of Mohs Micrographic Surgery: Europe . .

497

 

James A.A. Langtry

 

42

International Perspective of Mohs Micrographic

 

 

Surgery: East Asia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

503

 

Satoru Aoyagi

 

43

International Perspective of Mohs Micrographic

 

 

Surgery: Australia and New Zealand . . . . . . . . . . . . . . . . . . . . . . . . . . .

509

 

Greg Julian Goodman, Vanessa A. Morgan,

 

 

Tim J. Rutherford, Edward J. Upjohn, and Paul J.M. Salmon

 

44

Information for Patients and Safety Considerations . . . . . . . . . . . . . . .

519

 

Ilya Reyter, Abel Torres, and Neda Mehr

 

45

Ethical Issues Related to Mohs Skin Cancer Surgery . . . . . . . . . . . . . .

529

 

David J. Goldberg

 

46

Medicolegal Issues Regarding Mohs Micrographic Surgery . . . . . . . .

537

 

Ilya Reyter, Tanya Nino, and Abel Torres

 

47

Psychological Issues Regarding Mohs Micrographic Surgery . . . . . . .

549

 

Misha M. Heller, Tina Bhutani, Eric S. Lee, and John Koo

 

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

561