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Mohs Surgery: Technique, Indications, Applications, and the Future

Mohs Surgery: Technique, Indications, Applications, and the Future Abstract • Each year, it is estimated, more than 500,000 new cases of nonmelanoma skin cancer develop.1-3 The majority of these cutaneous neoplasms are treated by various modalities that include excision,4-6 electrodesiccation and curettage,7-9 cryosurgery,10,11 and irradiation,12,13 with greater than 90% success.3,14,15 Certain of the remaining primary tumors, as well as recurrent carcinomas, present a demanding therapeutic challenge. For these lesions, Mohs surgery has evolved as the most reliable and cost-effective treatment modality, offering maximal preservation of normal tissue and therefore the lowest functional and cosmetic morbidity.1,3,16-24 In this review, the history and evolution of Mohs surgery and the technique itself will be briefly outlined. The indications for Mohs surgery, together with methods of handling the postoperative wound and future applications of the technique, will be discussed in detail. (Arch Dermatol 1983;119:761-773) References 1. References 1-3,16-19,21-39,41,42,44. 2. References 1,3,21-24,36,37,45,53-63. 3. References 1,16,19,22-24,32,33-38. 4. References 2,3,16,21-24,36,37,40-43,46,51,52,56,76-79. 5. References 1,3,16,19,21-24,36,90. 6. Cottell WI, Proper S: Mohs surgery, fresh-tissue technique: Our technique with a review . J Dermatol Surg Oncol 1982;8:576-587.Crossref 7. Robins P: Mohs' surgery in the treatment of basal cell and squamous cell carcinomas of the skin , in Andrade R, Gumport SL, Popkin G, et al (eds): Cancer of the Skin. Philadelphia , WB Saunders Co, 1976, pp 1537-1550. 8. Levine H, Bailin P, Wood B, et al: Tissue conservation in treatment of cutaneous neoplasms of the head and neck . Arch Otolaryngol 1979;105:140-144.Crossref 9. Bart R, Schrager D, Kopf A, et al: Scalpel excision of basal cell carcinoma . Arch Dermatol 1978;114:739-742.Crossref 10. Rintala A: Surgical therapy of basal cell carcinoma: Correlation of the macroscopic and microscopic control of excision with recurrence . Scand J Plast Reconstr Surg 1971;5:87-96.Crossref 11. Binns J: Low incidence of recurrence in excised but noneradicated basal cell carcinomas . Br J Plast Surg 1975;28:133-138.Crossref 12. Reymann F: Basal cell carcinoma of the skin: Recurrence rate after different types of treatment: A review . Dermatologica 1980;161:217-226.Crossref 13. Knox JM, Lyles TW, Shapiro EM, et al: Curettage and electrodesiccation in the treatment of skin cancers . Arch Dermatol 1960;82:197-204.Crossref 14. Kopf AW, Bark RS, Schrager D, et al: Curettage: Electrodesiccation treatment of basal cell carcinomas . Arch Dermatol 1977;113:439-443.Crossref 15. Lubritz RR: Cryosurgical management of multiple skin cancers . J Dermatol Surg Oncol 1977;3:414-416.Crossref 16. Zacarian SA: Cryosurgery of skin cancer: In proper perspective . J Dermatol Surg Oncol 1975;1:33-38.Crossref 17. Pack G, Davis J: Radiation cancer of the skin . Radiology 1965;84:436-442.Crossref 18. Cobbett JR: Recurrence of rodent ulcers after radiotherapy . Br J Surg 1965;52:347-350.Crossref 19. Crissey JT: Curettage and electrodesiccation as a method of treatment for epitheliomas of the skin . J Surg Oncol 1971;3:287-290.Crossref 20. Albright SD: Treatment of skin cancer using multiple modalities . J Am Acad Dermatol 1982;7:143-171.Crossref 21. Mohs FE: Chemosurgery: Microscopically Controlled Surgery for Skin Cancer . Springfield, Charles C Thomas, 1978. 22. Pollack SV: Mohs' chemosurgery for skin cancer . Prog Dermatol 1980;14:1-4. 23. Swanson NA, Tromovitch TA, Stegman SJ: Mohs' chemosurgery 198O: Microscopically controlled excision . Aesth Plast Reconstr Surg 1981;3:6. 24. Mohs FE: Chemosurgery: Microscopically controlled surgery for skin cancer: Past, present and future . J Dermatol Surg Oncol 1978;4:41-42.Crossref 25. Swanson NA, Taylor WB: Commentary: The evolution of Mohs' surgery . J Dermatol Surg Oncol 1982;8:650-654.Crossref 26. Mikhail GR: Chemosurgery in the treatment of skin cancer . Int J Dermatol 1975;14:33-38.Crossref 27. Cottell WI: Mohs' surgery for carcinomas of the skin . Dallas Med J 1977;63:176-182. 28. Robins P: Chemosurgery: My 15 years of experience . J Dermatol Surg Oncol 1981;7:779-789.Crossref 29. Mohs FE: Chemosurgery for the microscopically controlled excision of cutaneous cancer . Head Neck Surg 1978;1:150-163.Crossref 30. Mohs FE: Chemosurgery: A microscopically controlled method of cancer excision . Arch Surg 1941;42:279-295.Crossref 31. Mohs FE, Guyer MF: Pre-excisional fixation of tissue in the treatment of cancer in rats . Cancer Res 1941;1:49-51. 32. Mohs FE: Chemosurgery: A method for microscopically controlled excision of cancer of the skin and lips . Geriatrics 1959;14:78-92. 33. Tromovitch TA, Beirne GA, Beirne CG: Cancer chemosurgery . Cutis 1965;1:523-529. 34. Phelan JT, Milgrom H: The use of the Mohs' chemosurgery technique of the treatment of skin cancers . Surg Gynecol Obstet 1967;125:549-560. 35. Robins P: Chemosurgery: A surer method to treat basal cell epithelioma . Consultant 1974;14:137-142. 36. Tromovitch TA, Beirne G, Beirne C: Mohs' technique (cancer chemosurgery): Treatment of recurrent cutaneous carcinomas . Cancer 1966;19:867-868.Crossref 37. Robins P, Menn H: Chemosurgery in the treatment of skin cancer . Hosp Pract 1970;5:40-50. 38. Mohs FE: Chemosurgery for skin cancer: Fixed-tissue and fresh-tissue technique . Arch Dermatol 1976;112:211-215.Crossref 39. Robins P, Albom MJ: Mohs' surgery: Fresh-tissue technique . J Dermatol Surg 1975;1:37-41.Crossref 40. Tromovitch TA, Stegman SJ: Microscopic-controlled excision . Dermatol Digest 1976;15:12-19. 41. Tromovitch TA, Stegman SJ: Microscopic-controlled excision of cutaneous tumors . Cancer 1978;41:653-658.Crossref 42. Stegman SJ, Tromovitch TA: Fresh-tissue chemosurgery for tumors of the nose . Eye Ear Nose Throat 1976;55:53-55. 43. Stegman SJ, Tromovitch TA: Modern chemosurgery: Microscopically controlled excision . West J Med 1980;132:7-12. 44. Koranda FC, Heffron ET, Modert CW, et al: Photo-mapping for microscopically controlled surgery . J Dermatol Surg Oncol 1982;8:463-465.Crossref 45. Braun M: The case for Mohs' surgery by the fixed-tissue technique . J Dermatol Surg Oncol 1982;7:634-635.Crossref 46. Peters CR, Dinner MI, Dolsky RL, et al: The combined multidisciplinary approach to invasive basal cell tumors of the scalp . Ann Plast Surg 1980;4:199-204.Crossref 47. Robins P, Amonette R: Chemosurgery and its clinical application . Hosp Med 1968;3:56-70. 48. Burg G, Hirsch RD, Birger K, et al: Histographic surgery: Accuracy of visual assessment of the margins of basal-cell epithelioma . J Dermatol Surg Oncol 1975;1:21-24.Crossref 49. Koplin L, Zarem HA: Recurrent basal cell carcinoma . Plast Reconstr Surg 1980;65:656-663.Crossref 50. Robins P, Bennett RG: Current Concepts in the Management of Skin Cancer . New York, Clinicom, 1979. 51. Mohs FE, Lathrop TG: Modes of spread of cancer of skin . Arch Dermatol 1952;66:427-439.Crossref 52. Salasche SJ, Amonette R: Morpheaform basal-cell epitheliomas: A study of subclinical extensions in a series of 51 cases . J Dermatol Surg Oncol 1981;7:387-392.Crossref 53. Robinson JK, Pollack SV, Robins P: Invasion of cartilage by basal cell carcinoma . J Am Acad Dermatol 1980;2:499-505.Crossref 54. Mark GJ: Basal cell carcinoma with intraneural invasion . Cancer 1977;40:2181-2187.Crossref 55. Weimar VM, Ceilley RI, Babin RW: Squamous-cell carcinoma with invasion of the facial nerve and underlying bone and muscle: Report of a case . J Dermatol Surg Oncol 1979;5:526-531.Crossref 56. Cottell WI: Perineural invasion by squamous-cell carcinoma . J Dermatol Surg Oncol 1982;8:589-599.Crossref 57. Panje WR, Ceilley RI: The influence of embryology of the mid-face on the spread of epithelial malignancies . Laryngoscope 1979;89:1914-1920.Crossref 58. Stegman SJ: Basal cell epitheliomas—sometimes . Consultant 1979; (Jan) :92-96. 59. Taylor GA, Barisoni D: Ten years' experience in the surgical treatment of basal-cell carcinoma: A study of factors associated with recurrence . Br J Surg 1973;60:522-525.Crossref 60. Shanoff LB, Spira MS, Hardy SB: Basal cell carcinoma: A statistical approach to rational management . Plast Reconstr Surg 1967;39:619-624.Crossref 61. Mora CG, Robins P: Basal-cell carcinomas in the center of the face: Special diagnostic, prognostic and therapeutic considerations . J Dermatol Surg Oncol 1978;4:315-321.Crossref 62. Levine JL, Bailin PL: Basal cell carcinoma of the head and neck: Identification of the high-risk patient . Laryngoscope 1980; 90:955-961.Crossref 63. Robins P, Albom MJ: Recurrent basal cell carcinomas in young women . J Dermatol Surg Oncol 1975;1:49-52.Crossref 64. Reymann F: Treatment of basal cell carcinoma of the skin with curettage . Arch Dermatol 1971;103:623-627.Crossref 65. Ceilley RI, Bumsted RM, Smith WH: Malignancies on the external ear: Methods of ablation and reconstruction of defects . J Dermatol Surg Oncol 1979;5:762-767.Crossref 66. Gormley DA, Hirsch P: Aggressive basal cell carcinoma of the scalp . Arch Dermatol 1978;114:782-783.Crossref 67. Binstock JH, Stegman SJ, Tromovitch TA: Large, aggressive basal cell carcinomas of the scalp . J Dermatol Surg Oncol 1981; 7:565-569.Crossref 68. Mohs FE, Zitelli JA: Microscopically controlled surgery in the treatment of carcinoma of the scalp . Arch Dermatol 1982; 117:764-769.Crossref 69. Barton FE: Principles of nasal reconstruction . J Dermatol Surg Oncol 1982;8:568-574.Crossref 70. Ceilley RI, Anderson RL: Microscopically controlled excision of malignant neoplasms on and around eyelids followed by immediate surgical reconstruction . J Dermatol Surg Oncol 1978; 4:55-62.Crossref 71. Baylis HI, Cies WA: Indications of Mohs' chemosurgical excision of eyelid and canthal tumors . Am J Ophthalmol 1975; 80:116-122. 72. Koranda FC, Grande DJ: Reconstruction of the upper helix of the ear . J Dermatol Surg Oncol 1982;8:477-481.Crossref 73. Tebbetts JB: Auricular reconstruction: Selected single-stage techniques . J Dermatol Surg Oncol 1982;8:557-566.Crossref 74. Thomas P: Treatment of basal cell carcinomas of the head and neck . Rev Surg 1970;27:293-294. 75. Caro MR, Howell JB: Morphea-like epithelioma . Arch Dermatol 1950;61:53-69. 76. Howell JB, Caro MR: Morphea-like epithelioma . Arch Dermatol 1957;75:517-524.Crossref 77. Freeman RH, Duncan WC: Recurrent skin cancer . Arch Dermatol 1973;107:395-399.Crossref 78. Freeman RH: Histopathologic considerations in the management of skin cancer . J Dermatol Surg Oncol 1976;2:215-219.Crossref 79. Kopf AW, Bart RS: Recurring basal-cell carcinoma following Mohs' surgery . J Dermatol Surg Oncol 1975;1:13-15.Crossref 80. Sloane JT: The value of typing basal cell carcinomas and predicting recurrence after surgical excision . Br J Dermatol 1977;96:127-131.Crossref 81. Mikhail GR, Nims LP, Kelly AP, et al: Metastatic basal cell carcinoma . Arch Dermatol 1977;113:1261-1269.Crossref 82. Kord JP, Cottel WI, Proper S: Metastatic basal-cell carcinoma . J Dermatol Surg Oncol 1982;8:604-608.Crossref 83. Amonette RA, Salasche SJ, Chesney TM, et al: Metastatic basal-cell carcinoma . J Dermatol Surg Oncol 1981;7:397-400.Crossref 84. Dvoretzky I, Fisher BC, Haker O: Mutilating basal cell epithelioma . Arch Dermatol 1978;114:239-240.Crossref 85. Safai B, Good RA: Basal cell carcinoma with metastasis . Arch Pathol Lab Med 1977;101:327-331. 86. Jackson R, Gardere S: Nevoid basal cell carcinoma syndrome . Can Med Assoc J 1971;105:850-860. 87. Mohs FE, Jones DC, Koranda FD: Microscopically controlled surgery for carcinomas in patients with nevoid basal cell carcinoma syndrome . Arch Dermatol 1980;116:777-779.Crossref 88. Pascal RR, Hobby LW, Lattes R, et al: Prognosis of `incompletely excised' versus `completely excised' basal cell carcinoma . Plast Reconstr Surg 1968;41:328-332. 89. Gooding C, White TG, Yatsuhashi M: Significance of marginal extension in excised basal cell carcinoma . N Engl J Med 1965;273:923-925.Crossref 90. Jackson R: Why do basal cell carcinomas recur (or not recur) following treatment? J Surg Oncol 1974;6:245-251.Crossref 91. Glass RL, Perez-Mesa CA: Management of inadequately excised epidermoid carcinoma . Arch Surg 1974;108:50-51.Crossref 92. Tromovitch TA, Beirne G, Beirne C: Cancer chemosurgery (Mohs' technique): The `chemo-check.' Arch Dermatol 1965;92:291-292.Crossref 93. Swanson NA, Tromovitch TA, Stegman SJ, et al: A novel method of re-excising incompletely excised basal-cell carcinomas . J Dermatol Surg Oncol 1980;6:438-439.Crossref 94. Menn H, Robins P, Kopf AW, et al: The recurrent basal cell epithelioma . Arch Dermatol 1971;103:628-631.Crossref 95. Cottell WI: Perineural invasion by squamous cell carcinoma . J Dermatol Surg Oncol 1982;8:589-600.Crossref 96. Robins P, Dzubow LM, Rigel DS: Squamous-cell carcinoma treated by Mohs' surgery: An experience with 414 cases in a period of 15 years . J Dermatol Surg Oncol 1981;7:800-801.Crossref 97. Knabel MR, Koranda FC, Panje WR, et al: Squamous-cell carcinoma of the upper lip . J Dermatol Surg Oncol 1982;8:487-491.Crossref 98. Siegle RJ, Swanson NA: Vulvar Bowen's disease . J Obstet Gynecol , in press. 99. Mohs FE, Sahl WJ: Chemosurgery for verrucous carcinoma . J Dermatol Surg Oncol 1979:5:302-306.Crossref 100. Swanson NA, Taylor WB: Plantar verrucous carcinoma: Literature review and treatment by Mohs' chemosurgery . Arch Dermatol 1980;116:794-797.Crossref 101. Headington JT: Verrucous carcinoma . Cutis 1978;21:207-211. 102. Headington JT, Teears R, Niederhuber JE, et al: Primary adenoid cystic carcinoma of skin . Arch Dermatol 1978;114:421-424.Crossref 103. Mohs FE, Blanchard L: Microscopically controlled surgery for extramammary Paget's disease . Arch Dermatol 1979;115:706-708.Crossref 104. Mohs FE: Chemosurgical treatment of melanoma . Arch Dermatol 1950;62:269-279. 105. Mohs FE: Chemosurgery for melanoma . Arch Dermatol 1977;113:285-291.Crossref 106. Swanson NA, Baker SR: Mohs' surgery: Techniques, indications, and applications in head and neck surgery : Read before the annual meeting of the American Academy of Facial Plastic Reconstructive Surgery, New Orleans, Oct 16, 1982. 107. Baker SR, Swanson NA: Complete microscopic controlled surgery for head and neck cancer . Head Neck Surg , in press. 108. Swanson NA, Grekin R, Baker SR: Mohs surgery in the treatment of head and neck surgery . Head Neck Surg , in press. 109. Albom MJ: The management of recurrent basal-cell carcinomas: Please, no grafts or flaps at once . J Dermatol Surg Oncol 1977;3:382-384.Crossref 110. Barton FE, Cottell WI, Walker B: The principle of chemosurgery and delayed primary reconstruction in the management of difficult basal cell carcinomas . Plast Reconstr Surg 1981;68:746-751.Crossref 111. Casson PR, Baker DC: Reconstruction of defects following Mohs' surgery . J Dermatol Surg Oncol 1981;7:811-817.Crossref 112. Robins P, Pollack SV, Robinson JK: Immediate repair of wounds following operations by Mohs' fresh-tissue technique . J Dermatol Surg Oncol 1979;5:329-336.Crossref 113. Swanson NA, Tromovitch TA, Stegman SJ: Reconstruction post-microscopically controlled excision . Aesthet Reconstr Fac Plast Surg 1981;6:3. 114. Bennett RG, Robins P: Repair of tissue defects resulting from removal of cutaneous neoplasms . J Dermatol Surg Oncol 1977;3:512-517.Crossref 115. Becker FF: Reconstruction of facial defects resulting from Mohs' chemosurgical procedures . J Dermatol Surg Oncol 1978;4:69-76.Crossref 116. Cameron RR, Latham WD, Dowling JA: Reconstructions of the nose and upper lip with nasolabial flaps . Plast Reconstr Surg 1973;52:145-149.Crossref 117. Bennett JE, Moore TS, Vellios F, et al: Surgical treatment of skin cancer of the nose . Am J Surg 1969;117:382-387.Crossref 118. Bennett JE, Thurston JG: Cancer of the nose: Ablation and repair . Clin Plast Surg 1976;3:461-468. 119. Cronin TA: Surgical repair of operative defects after skin cancer excision . J Fla Med Assoc 1976;63:71-72. 120. Stegman SJ: Planning closure of a surgical wound . J Dermatol Surg Oncol 1978;4:390-393.Crossref 121. Konz B: Use of skin flaps in dermatologic surgery of the face . J Dermatol Surg 1975;1:25-30.Crossref 122. Elias PM, Grayson S, Gross EG, et al: Influence of topical and systemic retinoids on basal cell carcinoma cell membranes . Cancer 1981;48:932-938.Crossref 123. Bailin PJ, Ratz JL, Lutz-Nagey L: CO2 laser modification of Mohs' surgery . J Dermatol Surg Oncol 1981;7:621-623.Crossref 124. Bentley TJ, Koranda FC, Miller LM: Histologic evaluation of horizontal frozen sections: Improved staining and special staining techniques . J Dermatol Surg Oncol 1982;8;466-470.Crossref 125. Carruthers C, Baumler A: Localization of fluoresceinlabeled antibodies of epidermal proteins in normal and malignant squamous epithelium . JNCI 1966;37:301-315. 126. Carruthers C, Baumler A: Immunochemical staining with fluorescein-labeled antibodies as an aid in the study of cancer formation . JNCI 1965;34:191-200. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Mohs Surgery: Technique, Indications, Applications, and the Future

Archives of Dermatology , Volume 119 (9) – Sep 1, 1983

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References (118)

Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1983.01650330053014
Publisher site
See Article on Publisher Site

Abstract

Abstract • Each year, it is estimated, more than 500,000 new cases of nonmelanoma skin cancer develop.1-3 The majority of these cutaneous neoplasms are treated by various modalities that include excision,4-6 electrodesiccation and curettage,7-9 cryosurgery,10,11 and irradiation,12,13 with greater than 90% success.3,14,15 Certain of the remaining primary tumors, as well as recurrent carcinomas, present a demanding therapeutic challenge. For these lesions, Mohs surgery has evolved as the most reliable and cost-effective treatment modality, offering maximal preservation of normal tissue and therefore the lowest functional and cosmetic morbidity.1,3,16-24 In this review, the history and evolution of Mohs surgery and the technique itself will be briefly outlined. The indications for Mohs surgery, together with methods of handling the postoperative wound and future applications of the technique, will be discussed in detail. (Arch Dermatol 1983;119:761-773) References 1. References 1-3,16-19,21-39,41,42,44. 2. References 1,3,21-24,36,37,45,53-63. 3. References 1,16,19,22-24,32,33-38. 4. References 2,3,16,21-24,36,37,40-43,46,51,52,56,76-79. 5. References 1,3,16,19,21-24,36,90. 6. Cottell WI, Proper S: Mohs surgery, fresh-tissue technique: Our technique with a review . J Dermatol Surg Oncol 1982;8:576-587.Crossref 7. Robins P: Mohs' surgery in the treatment of basal cell and squamous cell carcinomas of the skin , in Andrade R, Gumport SL, Popkin G, et al (eds): Cancer of the Skin. Philadelphia , WB Saunders Co, 1976, pp 1537-1550. 8. Levine H, Bailin P, Wood B, et al: Tissue conservation in treatment of cutaneous neoplasms of the head and neck . Arch Otolaryngol 1979;105:140-144.Crossref 9. Bart R, Schrager D, Kopf A, et al: Scalpel excision of basal cell carcinoma . Arch Dermatol 1978;114:739-742.Crossref 10. Rintala A: Surgical therapy of basal cell carcinoma: Correlation of the macroscopic and microscopic control of excision with recurrence . Scand J Plast Reconstr Surg 1971;5:87-96.Crossref 11. Binns J: Low incidence of recurrence in excised but noneradicated basal cell carcinomas . Br J Plast Surg 1975;28:133-138.Crossref 12. Reymann F: Basal cell carcinoma of the skin: Recurrence rate after different types of treatment: A review . Dermatologica 1980;161:217-226.Crossref 13. Knox JM, Lyles TW, Shapiro EM, et al: Curettage and electrodesiccation in the treatment of skin cancers . Arch Dermatol 1960;82:197-204.Crossref 14. Kopf AW, Bark RS, Schrager D, et al: Curettage: Electrodesiccation treatment of basal cell carcinomas . Arch Dermatol 1977;113:439-443.Crossref 15. Lubritz RR: Cryosurgical management of multiple skin cancers . J Dermatol Surg Oncol 1977;3:414-416.Crossref 16. Zacarian SA: Cryosurgery of skin cancer: In proper perspective . J Dermatol Surg Oncol 1975;1:33-38.Crossref 17. Pack G, Davis J: Radiation cancer of the skin . Radiology 1965;84:436-442.Crossref 18. Cobbett JR: Recurrence of rodent ulcers after radiotherapy . Br J Surg 1965;52:347-350.Crossref 19. Crissey JT: Curettage and electrodesiccation as a method of treatment for epitheliomas of the skin . J Surg Oncol 1971;3:287-290.Crossref 20. Albright SD: Treatment of skin cancer using multiple modalities . J Am Acad Dermatol 1982;7:143-171.Crossref 21. Mohs FE: Chemosurgery: Microscopically Controlled Surgery for Skin Cancer . Springfield, Charles C Thomas, 1978. 22. Pollack SV: Mohs' chemosurgery for skin cancer . Prog Dermatol 1980;14:1-4. 23. Swanson NA, Tromovitch TA, Stegman SJ: Mohs' chemosurgery 198O: Microscopically controlled excision . Aesth Plast Reconstr Surg 1981;3:6. 24. Mohs FE: Chemosurgery: Microscopically controlled surgery for skin cancer: Past, present and future . J Dermatol Surg Oncol 1978;4:41-42.Crossref 25. Swanson NA, Taylor WB: Commentary: The evolution of Mohs' surgery . J Dermatol Surg Oncol 1982;8:650-654.Crossref 26. Mikhail GR: Chemosurgery in the treatment of skin cancer . Int J Dermatol 1975;14:33-38.Crossref 27. Cottell WI: Mohs' surgery for carcinomas of the skin . Dallas Med J 1977;63:176-182. 28. Robins P: Chemosurgery: My 15 years of experience . J Dermatol Surg Oncol 1981;7:779-789.Crossref 29. Mohs FE: Chemosurgery for the microscopically controlled excision of cutaneous cancer . Head Neck Surg 1978;1:150-163.Crossref 30. Mohs FE: Chemosurgery: A microscopically controlled method of cancer excision . Arch Surg 1941;42:279-295.Crossref 31. Mohs FE, Guyer MF: Pre-excisional fixation of tissue in the treatment of cancer in rats . Cancer Res 1941;1:49-51. 32. Mohs FE: Chemosurgery: A method for microscopically controlled excision of cancer of the skin and lips . Geriatrics 1959;14:78-92. 33. Tromovitch TA, Beirne GA, Beirne CG: Cancer chemosurgery . Cutis 1965;1:523-529. 34. Phelan JT, Milgrom H: The use of the Mohs' chemosurgery technique of the treatment of skin cancers . Surg Gynecol Obstet 1967;125:549-560. 35. Robins P: Chemosurgery: A surer method to treat basal cell epithelioma . Consultant 1974;14:137-142. 36. Tromovitch TA, Beirne G, Beirne C: Mohs' technique (cancer chemosurgery): Treatment of recurrent cutaneous carcinomas . Cancer 1966;19:867-868.Crossref 37. Robins P, Menn H: Chemosurgery in the treatment of skin cancer . Hosp Pract 1970;5:40-50. 38. Mohs FE: Chemosurgery for skin cancer: Fixed-tissue and fresh-tissue technique . Arch Dermatol 1976;112:211-215.Crossref 39. Robins P, Albom MJ: Mohs' surgery: Fresh-tissue technique . J Dermatol Surg 1975;1:37-41.Crossref 40. Tromovitch TA, Stegman SJ: Microscopic-controlled excision . Dermatol Digest 1976;15:12-19. 41. Tromovitch TA, Stegman SJ: Microscopic-controlled excision of cutaneous tumors . Cancer 1978;41:653-658.Crossref 42. Stegman SJ, Tromovitch TA: Fresh-tissue chemosurgery for tumors of the nose . Eye Ear Nose Throat 1976;55:53-55. 43. Stegman SJ, Tromovitch TA: Modern chemosurgery: Microscopically controlled excision . West J Med 1980;132:7-12. 44. Koranda FC, Heffron ET, Modert CW, et al: Photo-mapping for microscopically controlled surgery . J Dermatol Surg Oncol 1982;8:463-465.Crossref 45. Braun M: The case for Mohs' surgery by the fixed-tissue technique . J Dermatol Surg Oncol 1982;7:634-635.Crossref 46. Peters CR, Dinner MI, Dolsky RL, et al: The combined multidisciplinary approach to invasive basal cell tumors of the scalp . Ann Plast Surg 1980;4:199-204.Crossref 47. Robins P, Amonette R: Chemosurgery and its clinical application . Hosp Med 1968;3:56-70. 48. Burg G, Hirsch RD, Birger K, et al: Histographic surgery: Accuracy of visual assessment of the margins of basal-cell epithelioma . J Dermatol Surg Oncol 1975;1:21-24.Crossref 49. Koplin L, Zarem HA: Recurrent basal cell carcinoma . Plast Reconstr Surg 1980;65:656-663.Crossref 50. Robins P, Bennett RG: Current Concepts in the Management of Skin Cancer . New York, Clinicom, 1979. 51. Mohs FE, Lathrop TG: Modes of spread of cancer of skin . Arch Dermatol 1952;66:427-439.Crossref 52. Salasche SJ, Amonette R: Morpheaform basal-cell epitheliomas: A study of subclinical extensions in a series of 51 cases . J Dermatol Surg Oncol 1981;7:387-392.Crossref 53. Robinson JK, Pollack SV, Robins P: Invasion of cartilage by basal cell carcinoma . J Am Acad Dermatol 1980;2:499-505.Crossref 54. Mark GJ: Basal cell carcinoma with intraneural invasion . Cancer 1977;40:2181-2187.Crossref 55. Weimar VM, Ceilley RI, Babin RW: Squamous-cell carcinoma with invasion of the facial nerve and underlying bone and muscle: Report of a case . J Dermatol Surg Oncol 1979;5:526-531.Crossref 56. Cottell WI: Perineural invasion by squamous-cell carcinoma . J Dermatol Surg Oncol 1982;8:589-599.Crossref 57. Panje WR, Ceilley RI: The influence of embryology of the mid-face on the spread of epithelial malignancies . Laryngoscope 1979;89:1914-1920.Crossref 58. Stegman SJ: Basal cell epitheliomas—sometimes . Consultant 1979; (Jan) :92-96. 59. Taylor GA, Barisoni D: Ten years' experience in the surgical treatment of basal-cell carcinoma: A study of factors associated with recurrence . Br J Surg 1973;60:522-525.Crossref 60. Shanoff LB, Spira MS, Hardy SB: Basal cell carcinoma: A statistical approach to rational management . Plast Reconstr Surg 1967;39:619-624.Crossref 61. Mora CG, Robins P: Basal-cell carcinomas in the center of the face: Special diagnostic, prognostic and therapeutic considerations . J Dermatol Surg Oncol 1978;4:315-321.Crossref 62. Levine JL, Bailin PL: Basal cell carcinoma of the head and neck: Identification of the high-risk patient . Laryngoscope 1980; 90:955-961.Crossref 63. Robins P, Albom MJ: Recurrent basal cell carcinomas in young women . J Dermatol Surg Oncol 1975;1:49-52.Crossref 64. Reymann F: Treatment of basal cell carcinoma of the skin with curettage . Arch Dermatol 1971;103:623-627.Crossref 65. 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Journal

Archives of DermatologyAmerican Medical Association

Published: Sep 1, 1983

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