title: A direct comparison of visual inspection, curettage, and epiluminescence microscopy in determining tumor extent before the initial margins are determined for Mohs micrographic surgery.
abstract: BACKGROUND
  Mohs micrographic surgery (MMS) is a tissue-sparing technique for the removal of cutaneous malignancies. There is no standardized procedure for determining tumor extent before taking the initial margins during the first stage of Mohs.
  
  
  OBJECTIVE
  To compare visual inspection, curettage, and dermoscopy in determining tumor extent before initial margins are taken for MMS.
  
  
  METHODS
  Fifty-four patients were randomized into three groups (visual inspection, curettage, or dermoscopy) before MMS for basal cell carcinomas on the nose. One of these three methods was used to delineate the biopsy site or residual tumor. The final number of stages and postoperative defect sizes were recorded.
  
  
  RESULTS
  There was no statistically significant differences for the final number of stages (p=.20) or the final defect sizes (p=.47) between the three arms.
  
  
  CONCLUSIONS
  There has been controversy as to whether presurgical curettage is appropriate before MMS. Some feel that curettage better delineates the tumor, leading to fewer stages, whereas others feel that curettage may falsely increase the final defect size, negating any tissue-sparing advantages of the procedure. Our study did not demonstrate any differences in the final number of stages or postoperative defect sizes between the three test groups.
authors.affiliation: Mystic Valley Dermatology Associates, Stoneham, Massachusetts 02180, USA. raguardiano@hotmail.com
authors.forename: Robert A
authors.initials: RA
authors.lastname: Guardiano
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Grande
mesh_terms: D002280:Basal Cell Carcinoma / Q000601:surgery*; D003475:Curettage; D046169:Dermoscopy; D006801:Humans; D015580:Mohs Surgery; D009367:Neoplasm Staging / Q000379:methods; D010808:Physical Examination; D011300:Preoperative Care; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery