[Mohs' micrographic surgery: history, principles, critical analysis of its efficacy and indications].
OBJECTIVE
To systematically review the literature for studies reporting on the role of Mohs' micrographic (MMS) surgery in the treatment of skin tumors. To show how it is performed in France.


METHODS
We reviewed with a quality grid all studies indexed in MEDLINE before 2003/01/01 and published in English or French. Data were extracted by two independent reviewers.


METHODS
Quality of clinical studies, recurrence rates, number of patients lost to follow-up.


RESULTS
No randomized study was found among the 493 references found. Studies of lower quality, on procedures similar to MMS, or previous systematic reviews were therefore selected. In tumors such as basal (BCC) or spinous (SCC) cell carcinoma, microcystic adnexal carcinoma, dermatofibrosarcoma protuberans, and Merkel cell carcinoma, MMS commonly induced lower recurrence rates than figures reported for conventional treatments and/or reduced surgical margins. Studies on melanoma were of low quality.


CONCLUSIONS
Although no evidence-based guidelines could be developed, MMS should be used mainly for larger, morphea, micronodular or infiltrative-type, or recurrent BCCs located in danger zones, but also (sometimes with a slightly modified procedure) in microcystic adnexal carcinomas, dermatofibrosarcoma protuberans, Merkel cell carcinoma, and in aggressive forms of SCC. Randomized, controlled studies should be performed.
Sei
J-F
JF
Service de Dermatologie, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, CHU Paris-Ile de France Ouest, Université de Versailles-Saint Quentin en Yvelines, Boulogne.
Chaussade
V
V
Zimmermann
U
U
Tchakerian
A
A
Clerici
T
T
Franc
B
B
Saiag
P
P
D006801:Humans; D015580:Mohs Surgery / Q000379:methods; D012878:Skin Neoplasms / Q000601:surgery*