title: Occurrence of subclinical tumor in excised facial subunits.
abstract: OBJECTIVE
  To determine the incidence of subclinical tumor in excised facial subunits in patients undergoing reconstruction after Mohs surgery.
  
  
  METHODS
  The study group comprised 45 patients who had their Mohs defects repaired by a facial plastic surgeon at a tertiary care center (university hospital). In the group, there were 74 biopsy-proved cutaneous neoplasms of the face. The median age of the group was 67 years. Nineteen patients (42%) had multiple tumors. There were 63 basal cell carcinomas (85%) and 11 squamous cell carcinomas (15%). Forty-seven tumors (64%) were primary and 27 (36%) were recurrent. Reconstruction of the defects was based on the principle of aesthetic subunits. Excised subunits were examined by the Mohs surgeon. Further excisions were performed, as necessary, if tumor was present in the subunit.
  
  
  RESULTS
  Five patients (11%) had subclinical basal cell carcinomas in their excised facial subunits. Four patients underwent further resections.
  
  
  CONCLUSIONS
  In patients with severe sun damage, recurrent tumors, and a history of skin cancer, clinically normal tissue excised during the reconstruction of their Mohs defects may contain subclinical tumor. Consequently, when these "high-risk" patients undergo reconstruction, excised facial subunits should be submitted for pathologic examination.
authors.affiliation: Department of Dermatology, Medical University of South Carolina and The Facial Surgery Center, Charleston, SC 29425, USA. watersa@musc.edu
authors.forename: Pearon G
authors.initials: PG
authors.lastname: Lang
authors.forename: Irenee M
authors.initials: IM
authors.lastname: Duncan
authors.forename: Marcelo
authors.initials: M
authors.lastname: Hochman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery / Q000009:adverse effects*; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D019651:Plastic Surgery Procedures; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery; D013472:Sunlight; D014947:Wounds and Injuries / Q000209:etiology / Q000601:surgery