MMS had a 33.3% (4/12) regional metastasis rate, while the group undergoing WLE had a 48.8% (20/41) regional metastasis rate. The group undergoing WLE had a mean 60-month follow-up, whereas the group treated with MMS had a mean 36-month follow-up.

currently known therapeutic options. The uncommon indications include DFSP, MAC, AFX, MFH, SC, MCC, melanoma, superficial leiomyosarcoma, and EMPD and are limited by smaller numbers of subjects in studies comparing standard surgical excision and Mohs Micrographic Surgery.

2.3.9Extramammary Paget’s Disease (EMPD)

EMPD is manifested as a slowly growing erythematous plaque that may have associated pruritus or burning. It is usually located in the anogenital or axillary regions, making tissue conservation in those areas highly desirable [64]. The histology is typified by Paget cells, which are large, pale-staining round cells [65]. There is usually epidermal acanthosis and hyperkeratosis [65]. Debate is currently ongoing whether EMPD is a continuously growing tumor. At least one review of 48 cases demonstrated that 15 anogenital lesions were multicentric [66]. Another report of 4 lesions requiring vulvectomy demonstrated that all 4 cases demonstrated multicentric features [67]. In addition, subclinical spread can be remarkable [68]. If MMS is used for EMPD, scouting biopsies and immunostaining with cytokeratin 7 may greatly facilitate extirpating the whole tumor [68]. Recurrence rates using WLE may be up to 44% [69], whereas when MMS is used, recurrence rates up to 18.2% have been reported [65].

Summary: Conclusion

•The indications for Mohs surgery can be divided into common and uncommon entities.

•Mohs micrographic surgery is associated with the lowest long-term recurrence rates amongst currently known therapeutic options for BCC and SCC.

2.4Conclusion

The indications for Mohs micrographic surgery can be divided into common and uncommon entities. The common entities, BCC and SCC, are backed by strong evidence that Mohs micrographic surgery is associated with the lowest long-term recurrence rates amongst

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