ABSTRACT
Mohs’ micrographic surgery is a well-known procedure that uses frozen histology to guide precise excision of skin cancers. The classic indication for Mohs’ surgery is non-melanoma skin cancer – i.e. basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). BCCs and SCCs occur most commonly on the face, with consequent functional and cosmetic implications following treatment. Mohs’ surgery has the highest cure rate as well as superior tissue conservation for primary and recurrent BCCs and SCCs, compared to any other treatment modality. 1
The Mohs’ procedure begins with excision of the tumor, followed by immediate preparation of frozen histologic sections. The surgeon examines the histologic sections for tumor in the peripheral and deep margins. If the margins are positive for tumor, another excision is performed and frozen histologic sections prepared. Excisions are performed and histologic sections prepared and examined in a repeated cycle until the last section is negative for cancer. Preparation and evaluation of frozen sections requires 20-45 minutes per excision. Furthermore, during the preparation, the patient has to wait under local
anesthesia with an open wound. Typically, two and often several more excisions are required, such that the procedure typically lasts 2 hours or longer. Thus, the Mohs’ procedure can be slow, tedious, and expensive. A non-invasive optical imaging modality, such as RCM, may enable rapid detection of BCCs and SCCs in fresh surgical skin excisions at the bedside during surgery and minimize the need for frozen histology. Confocal imaging may guide Mohs’ surgery in real time and benefit both the patient and the surgeon.
