title: Additional review of Mohs slides to optimize Mohs micrographic surgery.
abstract: BACKGROUND
  One significant risk factor for recurrence after Mohs surgery is misinterpretation of slides.
  
  
  OBJECTIVE
  To determine how often pathologists detected incompletely excised basal cell carcinoma (BCC) on Mohs slides and to determine risk factors for incompletely excised BCCs.
  
  
  METHODS
  This retrospective study included 1653 BCCs treated with Mohs surgery in a university hospital between 2007 and 2011. For routine quality assurance, all slides were additionally reviewed by a pathologist within 1 week of the procedure. For this study, all cases that had divergent interpretations were re-evaluated by a Mohs surgeon and a pathologist. Mixed-effects logistic regression models with Mohs surgeon effects as random effects were used to determine risk factors for incompletely excised BCC.
  
  
  RESULTS
  Incompletely excised BCCs were detected in 31 cases (2%), in which defects > 20 mm in diameter were an independent risk factor (odds ratio 3.58, 95% confidence interval 1.55-8.28). Other studied variables (i.e. aggressive subtype, previously treated BCC, location on nose and > 2 Mohs stages) did not affect the risk of incompletely excised BCCs.
  
  
  CONCLUSIONS
  The additional review of Mohs slides might increase accurate interpretation, especially in large BCCs.
authors.affiliation: Department of Dermatology, Erasmus University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
authors.forename: C B
authors.initials: CB
authors.lastname: van Lee
authors.affiliation: Department of Dermatology, Erasmus University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Graafland
authors.affiliation: Department of Dermatology, Erasmus University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Koljenović
authors.affiliation: Department of Dermatology, Erasmus University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
authors.forename: H A M
authors.initials: HA
authors.lastname: Neumann
authors.affiliation: Department of Dermatology, Erasmus University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Nasserinejad
authors.affiliation: Department of Dermatology, Erasmus University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
authors.forename: T E C
authors.initials: TE
authors.lastname: Nijsten
authors.affiliation: Department of Dermatology, Erasmus University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
authors.forename: R R
authors.initials: RR
authors.lastname: van den Bos
authors.affiliation: Department of Dermatology, Erasmus University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Munte
mesh_terms: D000368:Aged; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery*; D002983:Clinical Competence / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery / Q000592:standards*; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D018365:Neoplasm, Residual; D010338:Pathology, Clinical / Q000592:standards; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*