Dermatologist Dorinda Shelley wrote this short poem a few years back:
Who knows
Whose Nose
Needs Mohs?
The answer, of course, is "Your Dermatologist." Kidding aside, here are some thoughts about MMS that may be helpful in your decision making process.
“Mohs surgery depends on 2 very important concepts:
- The first is that microscope slides need to be prepared with en face sectioning, not a technique that is done rapidly or reliably in the pathology lab. It takes us over 6 months to train a technician to get the full face of the tissue, including epidermis, reliably. Without full face examination of the tissue, the procedure is simply excision with rush sections.
- The second crucial component is that the surgeon be the pathologist. This allows the greatest ability to excise the correct spot on any second or third stage. It is also important to understand the path, so you can excise to the correct layer.
No one has ever done a study to show that pseudo-Mohs is as effective as real Mohs. Imagine, depriving your patients of the real thing."
Here is a longer explanation: Download Mohs Micrographic Surgery
DermNet has a fine page on MMS. It concludes with this sentence: “The Mohs surgeon needs to have skills in dermatology, oncology, pathology and reconstructive surgery." We feel that plastic surgeons who perform pseudo-Mohs simply do not have the interest, training or expdertise to handle tumors in certain critical sites.