title: Presurgical curettage appropriately reduces the number of Mohs stages by better delineating the subclinical extensions of tumor margins.
abstract: BACKGROUND
  Whether presurgical curettage (PC), light curettage performed before Mohs surgery to delineate tumor margin, is appropriate or causes unnecessary removal of normal tissue has not been well established.
  
  
  OBJECTIVE
  We aim to determine histologically whether PC appropriately increases the size of the stage I specimen or causes unnecessary removal of healthy tissue.
  
  
  METHODS
  Before a surgical margin guided by PC was taken, a hypothetical margin determined by visual and tactile assessment alone (no curettage [NC]) was marked outside the clinically defined tumor. Histologic analysis at the NC and the PC margins revealed whether the increase in the stage I specimen as a result of PC was appropriate.
  
  
  RESULTS
  PC appropriately increased the stage I specimen in 21 cases and unnecessarily removed normal tissue in only 1 case. The estimation of tumor margins with PC was 15 times more accurate than with NC (p value = .0012).
  
  
  CONCLUSIONS
  For basal cell and squamous cell carcinomas at least 4 mm in diameter, light curettage performed prior to Mohs surgery could better delineate subclinical extensions of the tumor margin and appropriately increase the size of the stage I specimen.
authors.affiliation: Dermatology Surgery Unit, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
authors.forename: Vinh Q
authors.initials: VQ
authors.lastname: Chung
authors.forename: Leo
authors.initials: L
authors.lastname: Bernardo
authors.forename: S Brian
authors.initials: SB
authors.lastname: Jiang
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; D003475:Curettage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D009367:Neoplasm Staging; D011300:Preoperative Care; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome