In the early 1970s, Dr. Mohs [1], and Stegman and Tromovitch [2], in selected cases, would omit the zinc chloride fixative and use a local anesthetic to remove the tissue. This became known as the “fresh tissue” technique. Once it was realized that the cure rate with the “fresh tissue” technique was as good as it was with the “fixed tissue” technique and that the transection of tumor did not lead to metastases, Mohs surgery became a much less painful and much more accepted procedure for treating skin cancer. Moreover, the “fresh tissue” technique permitted immediate repairs, which eventually resulted in Mohs surgeons becoming very accomplished reconstructive surgeons. This also allowed most patients to have their surgery completed in a single day by one surgeon. The advent of the “fresh tissue” technique also resulted in a series of changes in the name of the procedure and the Mohs College. Because the “fixed tissue” technique was rarely used and the term “chemosurgery” carried with it inappropriate connotations, the term was replaced by the term “microscopically controlled surgery.” However, because the use of routine frozen sections could be considered microscopically controlled surgery, it was decided that a more descriptive term be used. This resulted in the name “Mohs micrographic surgery.” In tandem with these changes in the name of the procedure came changes in the name of the organization. Initially it was known as the American College of Mohs Chemosurgery. Once the use of the “fresh tissue” technique became prevalent, the College changed its name to the American College of Mohs Micrographic Surgery and Cutaneous Oncology. Although very descriptive and appropriate, it was later felt by the Public Relations Committee that it was not a name easily remembered by the public and that in order to promote the procedure and organization, it would be preferable to shorten the name to the American College of Mohs Surgery.

For many years, the pharmacy at the University of Wisconsin served as a source for the zinc chloride

fixative. However, it is no longer available. One of the authors (PGL) has used other sources for this paste and did not like the preparation as well.

In addition to being used to treat skin cancer, Mohs chemosurgery proved to be useful in the management of other cancers and noncancerous conditions including gangrene, infected unresectable carcinomas, unusual cutaneous infections, and chest wall recurrences of breast cancer.

Summary: Conclusion

•The fixed tissue technique is rarely used today.

•A multidisciplinary approach to difficult skin cancers has largely supplanted the fixed tissue technique.

7.2Conclusion

Today, the fixed tissue technique is rarely used and is mainly of historical significance. A multidisciplinary approach to difficult skin cancers has largely supplanted the need for the fixed tissue technique. This, in combination with the fact that the fixative is in short supply and that only the more senior Mohs surgeons have the expertise to use the fixative, has meant that the “fixed tissue” technique has become a dying art.

References

1.Mohs FE. Chemosurgery. Microscopically controlled surgery for skin cancer. Springfield: Charles C. Thomas; 1978. p. 106.

2.Tromivitch TA, Stegman SJ. Microscopically controlled excision of skin tumors: chemosurgery (Mohs) fixed tissue technique. Arch Dermatol. 1974;110:231–2.