What is included in the dermatologic preoperative evaluation and management for Mohs micrographic surgery?

Updated: Mar 16, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

Answer

Patients with skin cancer require detailed information about the possibility of an extensive defect. The defect after Mohs treatment cannot always be determined during the time of the preoperative evaluation. Vital structures, such as nerves, may be sacrificed during extensive surgeries. Repercussions of the cancer treatment should be outlined. Options for wound closure should be discussed and include healing by secondary intention, primary closure, flap, or graft. At times, a multidisciplinary approach may be needed. Reassure the patient that a revision in the future is possible. Recurrences are possible, and patients with skin cancer should be carefully monitored posttreatment. In vivo reflectance confocal microscopy of basal cell carcinomas may aid in preoperative mapping of cancer margins. [24]

Shared medical appointments have been advocated for patients prior to Mohs micrographic surgery, providing multiple patients with appropriate information on skin cancer and its treatment. This concept was used in a study of 149 patient for the Mohs preoperative consultation and earned a high patient satisfaction rate. [25]


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