๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
NEW DIRECTIONS
NEW DIRECTIONS
Evidence supports the use of MMS for the treatment of melanoma and rarer cutaneous malignancies, such as dermatofibrosarcoma protuberans, atypical fibroxanthoma, microcytic adnexal carcinoma, malignant fibrous histiocytoma, adenocystic carcinoma, apocrine/eccrine carcinoma, mucinous carcinoma, leiomyosarcoma, and sebaceous carcinoma.6 Among these tumors, MMS is being increasingly used as an alternative to standard excision for certain melanomas. Melanocytes are difficult to assess on routine frozen section,38 but with advances in immunohistochemistry, Mohs surgeons overcome this challenge by using special stains that better highlight these cells. Kelley et al. reported 100% correlation between paraffin-embedded permanent sections and frozen sections stained with MART-1.54 As laboratory-staining techniques improve, Mohs surgery may play an increasing role in the treatment of melanoma. For a full discussion of Mohs approaches to melanocytic lesions, see Chapter 31.
CONCLUSIONS
Understanding the fundamental techniques of MMS permits the physician to appreciate the specific instances when patients will best benefit from this procedure. The techniques of MMS have continued to evolve since its introduction by Dr. Frederic Mohs, and some variation persists between Mohs surgeons. A significant benefit of this approach is that the Mohs surgeon serves as the pathologist, lowering the potential for human error in a situation where tissue orientation is of critical importance. The
accuracy and skill applied at each step of the procedure lead to the consistently high cure rates balanced by maximal tissue conservation. Newer directions, particularly the use of immunohistochemical stains to permit effective treatment of melanoma, continue to permit this technique to remain at the cutting edge of dermatologic surgery and surgical oncology.