title: Identifying and managing those patients at risk for aborted mohs micrographic surgery.
abstract: BACKGROUND
  Treatment of nonmelanoma cutaneous carcinoma with Mohs micrographic surgery (MMS) is a well-recognized therapy. However, there are infrequent times when MMS must be aborted before achieving adequately clear margins. Reasons cited by those who have aborted MMS include patient discomfort and/or concern regarding damage to deeper structures.
  
  
  METHODS
  A retrospective cohort was created consisting of patients who were referred for reconstructive procedures following MMS during a 4-year period. Patients who experienced aborted MMS were identified from this cohort, and a chart review performed.
  
  
  RESULTS
  The overall occurrence of aborted MMS in the community was significantly less than 1% with a cumulative frequency in this particular reconstructive cohort of 1.7%. Approximately one-third of patients had persistent tumor on subsequent treatment, and approximately 14% required multiple excisional procedures to clear tumor. Risk factors for experiencing aborted MMS include histology of dermatofibroma sarcoma protuberans, significant pain during MMS, and location of tumor over a cranial nerve. Follow-up failed to reveal recurrence after further treatment.
  
  
  CONCLUSIONS
  Preoperative identification of patients at risk for aborted MMS would allow for direct referral using surgical excision, hence decreasing anxiety, morbidity, and cost. A treatment algorithm is proposed for patients who experience aborted MMS.
authors.affiliation: Division of Plastic Surgery, Clara Maass Medical Center, Belleville, NJ, USA. risz@ix.netcom.com
authors.forename: Ross I S
authors.initials: RI
authors.lastname: Zbar
mesh_terms: D000465:Algorithms; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D003661:Decision Support Techniques; D018223:Dermatofibrosarcoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D015580:Mohs Surgery; D010146:Pain / Q000209:etiology; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D012509:Sarcoma / Q000473:pathology / Q000601:surgery*; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D017211:Treatment Failure