Mohs micrographic surgery

Meet the patient

A 70-year-old man returns six months after a standard excision of a basal cell carcinoma on his nasal ala. The scar is healed, but a pearly, telangiectatic nodule has crept back at its medial edge — and the lesion now sits squarely in the H-zone of the face: perinasal skin, nasal ala, free margin.[1][4]

Two questions decide whether he keeps his ala or loses it to serial recurrence: why did it come back? and what surgical method actually proves the margin is clear this time? The answer to both is subclinical extension defeating bread-loaf sampling — and the remedy is Mohs.[1][3]

The name is the method — micrographic means mapped

Mohs is one operation that fuses complete histological margin control with maximal tissue conservation, all on the same day. The surgeon removes the clinically apparent tumour with a narrow rim of skin, then maps, colour-codes, freezes, sections, stains, and reads the entire peripheral and deep margin while the patient waits in the chair. Wherever tumour touches the edge, the surgeon returns to that exact spot, takes another thin layer, and repeats — until the whole margin is histologically clear. Only then is the defect reconstructed.[1][3]

The name is precise, and it earns marks at viva. Micrographic comes from the Greek graphos, "drawn" — it refers to the map that links every piece of removed tissue back to its anatomical origin on the patient. Microscopically controlled means the resection is governed by what the microscope shows, not by a fixed distance of normal skin. The newer synonym CCPDMA — complete circumferential peripheral and deep margin assessment — says the same thing more plainly: the entire true margin is examined, not a sample of it.[1]

A Wisconsin surgeon, zinc chloride, and the 1930s

The technique is the work of Frederic E. Mohs, a general surgeon at the University of Wisconsin, who built it in the 1930s to study cancer in rats. His original chemosurgery painted 20% zinc chloride paste onto the tumour in the living patient, fixing and hardening the tissue in situ; the fixed specimen was excised the next day and sectioned horizontally. The zinc chloride did double duty — chemical fixation plus a degree of anaesthesia — and, crucially, let the fixed block be cut en face so the entire margin could be inspected.[3]

Reliable, but painful, slow (a layer a day), and it left a stiff eschar that delayed healing. In 1953, operating on an eyelid where zinc chloride was too destructive, Mohs switched to excising fresh, unfixed tissue and processing it as frozen sections — the fresh-tissue technique used today. It proved superior, and within two decades fresh tissue had displaced chemosurgery at nearly every site. In the 1970s, Tromovitch and Stegman popularised the fresh-tissue method and coined the modern name Mohs (micrographic) surgery, honouring the inventor while burying the obsolete fixed-tissue technique.[3]

Who walks through the Mohs door — and why

Mohs exists for the tumours it treats, and the tumour it treats most is basal cell carcinoma — the commonest cancer in humans. BCC makes up roughly 70 to 80% of non-melanoma skin cancer, with cutaneous SCC most of the rest. Lifetime risk peaks in fair-skinned (Fitzpatrick I to II) populations with chronic ultraviolet exposure, and is steepest in Australasia, where about one person in two will develop an NMSC by age 70.[1][4]

The Mohs indications map cleanly onto the epidemiology of high-risk NMSC. What makes a tumour biologically dangerous is exactly what makes standard excision unreliable — and these factors cluster into recognisable patient phenotypes:[1]

For these patients Mohs is not an occasional referral but the default surgical pathway for any new facial NMSC. Standard excision, with its under 1% margin sampling, fails precisely where these patients need it most — on a face where subclinical extension is invisible and every recurrence steals another scarce cosmetic subunit.[1][4]

Why Mohs wins — 100% versus under 1%

The mantra to carry into every viva: 100% of the margin, read by the surgeon who cut it — same day. Everything else follows from that one line. Two technical choices make it possible, and both are examinable.[3]

First, the specimen is processed horizontally (en face). The saucerised disc is flipped rim-down onto the cryostat chuck so that a single microtome cut samples the entire peripheral edge and the deep dermal and subcutaneous margin in one plane. Every cell sitting at the true margin is therefore on the slide.[1][3]

Second, the surgeon who operated reads their own slides — trained as both surgeon and dermatopathologist. Because the surgeon drew the colour-coded map, they know exactly where each piece of tissue came from. Tumour found at the 3 o'clock edge sends them back to 3 o'clock on the wound, and only that area is re-excised. This closed-loop feedback is what makes Mohs both curative and tissue-sparing.[3]

By contrast, standard wide local excision fixes the specimen in formalin and slices it into a series of vertical cross-sections — "bread-loaves." Only the cut face of each slab is examined, a fraction (under 1%) of the whole margin. Tumour hiding in the unsampled gaps between slices is invisible, so a "clear" report from standard pathology does not prove the margin is clear — it proves the sampled slices are clear. That is the single most important sentence to say out loud at viva: standard excision has high sensitivity for bulk disease and low sensitivity for the subclinical skip extension that aggressive facial tumours live by.[1][3]

The reason it matters is subclinical extension — tumour reaching microscopically past what the eye can see. The magnitude is subtype-dependent and examinable. A nodular BCC on the trunk clears with a 4 mm margin in over 95% of cases; a morpheaform or infiltrative BCC extends more than 1 cm in roughly a third of cases and more than 2 cm in a smaller but real minority. On the face this is amplified by the embryonic fusion planes — the H-zone, where ectoderm fused in utero — along which BCC prefers to track. Those same planes make recurrence after standard excision highest on the nose, perinasal, periauricular and perioral skin, and SCC behaves no better there.[1][4]

The pre-operative round — histology, extent, danger anatomy, repair

Mohs is planned around the tumour's biology and the anatomy it occupies, so the pre-operative assessment decides both whether Mohs is right and how the defect will be rebuilt. Run it in four layers: confirm the histology, define the clinical and subclinical extent, map the danger anatomy, and plan the repair.[1][3]

Confirm the histology. A pre-operative biopsy is mandatory — a shave for nodular BCC, a punch for sclerosing, recurrent or deeply infiltrative lesions — read by a dermatopathologist. The biopsy nails the diagnosis, the histological subtype (which sets subclinical-extension risk: morpheaform and infiltrative greater than micronodular greater than nodular greater than superficial), the SCC grade, and any perineural or lymphovascular invasion. Any one of those can upgrade a "low-risk" lesion into a Mohs indication — and even a superficial-only BCC on biopsy mandates Mohs if the clinical look suggests deeper disease.[4]

Define the clinical and subclinical extent. Dermoscopy, and increasingly reflectance confocal microscopy and optical coherence tomography, delineate the true border of poorly defined or pigmented tumours. Mark the lesion and a margin under good light with the patient seated upright, so gravity does not distort the facial subunits. Photograph at rest and with animation — both to document the lesion and to plan a repair that preserves facial movement.[2]

Map the danger anatomy. Before any cut, mark the facial nerve danger zones — the temporal branch crossing a line from 0.5 cm below the tragus to 1.5 cm above the lateral brow, and the marginal mandibular branch along the jawline. Identify the free margins of eyelids, lips and nasal ala, where wound contraction causes ectropion, eclabium and alar notching. Note any previous scars or flaps that restrict local tissue movement.[2]

[2]

Investigations for the high-risk tumour. Routine bloods are not needed for Mohs. But for clinically enlarged nodes (palpable cervical, parotid or axillary lymphadenopathy) on SCC, Merkel cell carcinoma or aggressive BCC, request ultrasound or CT of the regional nodes first, and raise sentinel node biopsy for Merkel cell within the MDT. For large (over 2 cm), fixed, or deeply infiltrative tumours, or when perineural invasion is reported on biopsy, MRI (skull base, cavernous sinus, large-nerve involvement) or CT (maxilla or mandible bone invasion) decides whether Mohs alone is enough or whether parotidectomy, neck dissection or adjuvant radiotherapy must be staged around it.[2]

Consent. Tell the patient the day takes several hours (mostly waiting between stages), that same-day reconstruction may need a flap or graft, that a small minority (under 5%) return for a second day, and that bleeding, infection, nerve injury and recurrence are the recognised risks. Setting expectations on the cosmetic result — including that the scar matures over 12 to 18 months — is part of consent, not an afterthought.[2]

One stage, eight moves, read your own slides

Mohs is an outpatient, single-day procedure under local anaesthesia — typically 1% lidocaine with adrenaline, maximum 7 mg/kg (plain lidocaine near end-appendages). A "stage" or "layer" is one complete excise-map-freeze-read cycle, repeated until clear.[3]

Three technical points earn marks. The 45 degree bevel and the saucerised deep surface are not cosmetic flourishes — they are what let the disc invert and flatten so the peripheral edge and deep margin lie in one sectioning plane; lose the bevel and the rim buckles and cannot be read as a continuous line. The reference notches (small cuts at known clock positions) plus dye colour-coding are the geometric link from slide back to patient: a red-dye tumour at 3 o'clock on the map sends the surgeon to 3 o'clock on the wound. Reading speed — 15 to 30 minutes per stage, against days for permanent paraffin — is what makes same-day completion possible.[3]

The classic trap, and the one examiners love: a Mohs frozen section is not the same as a "frozen section." The generic intra-operative frozen section that a general or ENT surgeon orders is a single representative vertical cut sent to a separate pathologist, sampling only a fraction of the margin. Mohs sections are horizontal en-face preparations of the entire true margin, read by the operating surgeon off a mapped specimen. The phrase that earns the mark is complete circumferential margin assessment (Mohs) versus representative margin sampling (frozen section). Say "Mohs is just frozen sections," and you have just failed that stem.[3]

When to send for Mohs — the H-zone and beyond

The Appropriate Use Criteria for Mohs, jointly built by the American Academy of Dermatology, the American College of Mohs Surgery and allied societies, sort indications into three buckets: absolute (first-line), relative, and not indicated. Learn the buckets, and the margins fall out of them.[1][3]

Absolute indications — Mohs first-line

[6]

Relative indications

Relative indications are where Mohs is preferred but standard excision with an adequate margin is acceptable if Mohs is unavailable:[1]

• Tumours over 2 cm in diameter at any site.
• Young patients (under 40) — high lifetime recurrence risk, and the most to gain cosmetically from tissue conservation.
• Any lesion where maximum tissue conservation matters (cosmetic units, large trunk lesions, the elderly with comorbidity).
• Any BCC or SCC in a patient who has already had multiple skin cancers.[1]

Not routinely indicated — do not over-treat

Mohs is over-treatment for:[3]

• Low-risk BCC or SCC on the trunk or extremities — well-defined, under 2 cm, nodular or superficial histology. Standard excision with a 4 mm margin (BCC) or 4 to 6 mm margin (SCC) cures equivalently at lower cost.
• Invasive melanoma — standard excision with margins set by Breslow thickness (1 cm for in situ or under 1 mm; 1 to 2 cm for 1.01 to 2 mm; 2 cm for over 2 mm) remains the standard. Mohs for invasive melanoma is controversial because frozen-section melanoma cytology is unreliable, and in-transit or satellite disease is not a margin problem.
• The exception is lentigo maligna (melanoma in situ on chronically sun-damaged skin), where subclinical extension is notorious and the standard 5 mm margin is frequently inadequate. Here Mohs (often with MART-1 immunostaining) or modified slow-Mohs with paraffin sections is increasingly used.[8]

[5]

The rarer tumours that live or die by their margins

BCC and SCC dominate Mohs by volume, but a handful of rarer tumours are first-line Mohs indications in their own right — either because their subclinical extension defeats standard margins or because tissue conservation on the face is at a premium. Each earns a one-paragraph defence at viva.[6]

Dermatofibrosarcoma protuberans (DFSP) is the paradigm. This low-grade dermal sarcoma infiltrates subcutaneous fat in a honeycomb lace of slender CD34-positive spindle cells that run far beyond the visible plaque. Standard wide local excision with 2 to 3 cm margins still left historical local recurrence of 20 to 50%, because the residual tentacles were missed. Slow-Mohs with permanent paraffin sections and CD34 immunostain drops local recurrence to under 2 to 5% while sparing normal tissue — the modern standard of care for DFSP wherever Mohs is available.[6]

Atypical fibroxanthoma (AFX) and its deeper variant pleomorphic dermal sarcoma arise on the sun-damaged head and neck of the elderly. AFX is locally aggressive but rarely metastasises, and Mohs gives complete margin control and high cure. The deeper pleomorphic variant behaves like a sarcoma and is managed with the MDT, sometimes with adjuvant radiotherapy.[6]

Merkel cell carcinoma is a neuroendocrine skin cancer with a taste for lymphatic spread and recurrence, so Mohs only settles the primary site. Sentinel node biopsy, imaging, and the question of adjuvant radiotherapy are decided by the MDT. Slow-Mohs or modified Mohs with CK20 immunostaining confirms clearance of the subtle dermal infiltrate.[7]

Extramammary Paget disease (vulval, scrotal, perianal) spreads in multifocal skip lesions through the epidermis that clinical margins cannot capture. Slow-Mohs with cytokeratin-7 immunostaining maps the true extent and cuts the recurrence rate sharply versus wide excision.[6]

Microcystic adnexal carcinoma (sclerosing sweat duct carcinoma) burrows deep along nerves and into muscle with perineural invasion, so standard excision is frequently margin-positive. Mohs is the surgical treatment of choice.[6]

Lentigo maligna (melanoma in situ on chronically sun-damaged skin) is the one melanocytic tumour for which Mohs is increasingly accepted. Subclinical extension is notorious — 5 mm margins clear only roughly 60 to 70% — so Mohs with MART-1 (Melan-A) immunostaining or slow-Mohs with paraffin sections achieves histological clearance while sparing facial skin, with reported recurrence under 2%.[8]

SCC in situ (Bowen disease) on the face or digit, and verrucous carcinoma, are relative indications: Mohs is chosen when standard excision would sacrifice a critical structure (eyelid margin, nail unit, digit tip) or when the lesion is large and poorly defined.[6]

For invasive melanoma, as above, standard excision with Breslow-based margins remains the rule; Mohs is the exception, reserved for the in-situ lentigo maligna pattern.[3]

Standard versus slow Mohs — when a single cell at the margin matters

Two processing variants exist, and the distinction is tested every year.[6]

Slow Mohs (modified Mohs with permanent sections) is chosen when a single malignant cell at the margin matters and frozen-section morphology cannot be trusted — DFSP (CD34-positive slender cells threading through fat), lentigo maligna (atypical melanocytes along the basal layer, easily missed on H and E frozen), Merkel cell carcinoma, and extramammary Paget disease.[6][8] The price is that reconstruction is deferred for 24 to 48 hours while the defect is dressed.

A related variant is the square procedure (Mohs with a peripheral in-continuity margin), used for lentigo maligna: a peripheral rim of skin is removed and processed as one continuous strip so the entire perimeter is read in a single block.[8]

The cure rates — reproduce them verbatim

Mohs delivers the highest published cure rates of any skin-cancer treatment. Memorise these numbers and quote them exactly.[1][3]

[1] [6]

For comparison, standard excision manages roughly 90 to 95% cure for primary BCC and 80 to 85% for recurrent BCC — and the gap widens exactly where Mohs is indicated (face, recurrent, aggressive). Cosmetic outcomes are excellent because Mohs is tissue-sparing — only tumour-positive tissue is removed — and the same surgeon reconstructs on the same day, knowing the exact defect dimensions.[4][2]

Mohs versus standard excision — and the other NMSC treatments

For low-risk trunk and extremity tumours the other NMSC treatments also have a place, set against Mohs: curettage and electrodesiccation (high cure for small low-risk nodular BCC, but no histological margin control and a white atrophic scar); cryotherapy (actinic keratoses and selected superficial BCC); radiotherapy (patients unfit for surgery, or where surgery would be mutilating; contraindicated in Gorlin syndrome and in previously irradiated fields); and topical 5-fluorouracil and imiquimod (superficial BCC, actinic keratoses, Bowen disease; no margin control). Not one of them examines the margin, so none can match Mohs for a high-risk tumour.[4]

Rebuilding the defect — the reconstructive ladder

Once the margins are clear, the surgeon repairs the defect using the reconstructive ladder, picking the rung that best restores form and function for that anatomical subunit.[2]

1. Second-intention healing (let it granulate and contract) — best for concave sites (temple, medial canthus, conchal bowl, postauricular sulcus), where contraction pulls the wound into a natural contour; convex sites heal with a depressed scar.
2. Primary closure (side-to-side) — for small defects with lax surrounding skin; convert to an ellipse along the resting skin tension lines and excise the dog-ears.
3. Local flaps (advancement, rotation, transposition such as rhomboid and bilobed) — for nasal, cheek, perioral and periauricular defects; redistribute adjacent tissue of matching colour and texture, and rebuild subunits (nasal tip, ala, helical rim) as units.
4. Skin grafts (split- or full-thickness) — for large defects or those exposing cartilage or bone without a vascular bed for a flap; full-thickness for the face (better colour match), split-thickness for large trunk or scalp; secured with a tie-over bolster.[6]

Because the surgeon knows the exact final defect size and that every margin is negative before closing, reconstruction after Mohs is more reliable than after standard excision — where a positive margin can force a re-operation through a freshly closed wound.[2]

What can go wrong — complications and the two technique pitfalls

Two pitfalls are specific to the technique. Frozen-section artefact can hide single atypical cells — which is exactly why slow-Mohs with permanent paraffin and immunostains is preferred for DFSP, lentigo maligna and Merkel cell carcinoma. And inadequate mapping: if the colour-code or notation is wrong, the surgeon returns to the wrong site and the tumour is missed. This is why Mohs is done only by formally trained, fellowship-educated surgeons.[3]

Special populations — who still gets Mohs

• Immunosuppressed patients (solid-organ transplant recipients, chronic lymphocytic leukaemia, HIV with low CD4) develop more aggressive, more recurrent and more metastatic NMSC. Mohs is indicated for essentially all NMSC in this group, with lifelong surveillance because new and recurrent tumours keep coming.[1]
• Anticoagulated patients (warfarin, DOACs, aspirin, clopidogrel): current practice is to continue anticoagulation for Mohs, because the thromboembolic risk of interruption exceeds the bleeding risk of a superficial skin procedure under careful local haemostasis. Bridging is rarely needed; the decision is individualised. Have electrocoagulation and absorbable haemostatic agents ready.[2]
• Pacemakers and implantable defibrillators: use bipolar electrosurgery (or battery-operated heat cautery) instead of monopolar, so no current passes through the device. Avoid grounding plates.[2]
• Paediatric patients: Mohs is occasionally used for congenital or paediatric skin tumours (DFSP, giant congenital melanocytic naevus with atypia, basal cell naevus syndrome). The technique is identical, but sedation and cooperation must be managed, and second-intention healing is favoured where possible.[1]
• Pregnancy: Mohs can be done safely in any trimester under local anaesthesia; large reconstruction can wait until post-partum. Lidocaine with adrenaline is safe; avoid NSAIDs in the third trimester for post-operative analgesia.[2]

The evidence base, the guidelines, and two live controversies

The evidence behind Mohs rests on decades of large prospective cohort series — not randomised trials, which are ethically awkward when one arm forgoes margin control. The seminal long-term data come from Mohs's own Wisconsin series and from Rowe and colleagues' systematic reviews, repeatedly showing 5-year cure of 99% for primary BCC and 95% for recurrent BCC, against 90 to 95% and 80 to 85% for standard excision. The Appropriate Use Criteria for Mohs Micrographic Surgery (2012, updated), jointly authored by the AAD, ACMS, ASDS and AAD, codify the indications used worldwide.[1]

[1]

Two genuine controversies remain. Mohs for invasive melanoma is not standard, for three reasons: frozen-section melanoma cytology at the margin is unreliable and inflammation mimics tumour; melanoma spreads lympho-haematogenously, so local margin is not the sole determinant of outcome; and Breslow-based excision margins are well-validated by randomised trials. The exception is lentigo maligna (in-situ melanoma on sun-damaged skin), where subclinical extension defeats the standard 5 mm margin — here Mohs with MART-1 immunostaining or slow-Mohs achieves higher clearance and lower recurrence, and is increasingly accepted. The cost-effectiveness debate is the second: Mohs costs more per procedure but saves system cost for high-risk tumours.[8]

Emerging adjuncts — 3D whole-specimen imaging and digital pathology to speed slide reading, artificial intelligence for margin interpretation, and 3D bioprinting for defect reconstruction — are all still adjuncts to, not replacements for, the mapped en-face principle.[5]

Who is allowed to do Mohs — and why it is not delegable

Mohs is done only by physicians who have completed a dedicated Mohs micrographic surgery fellowship — most often the 1 to 2 year fellowship of the American College of Mohs Surgery (ACMS), after dermatology residency. The fellowship trains the surgeon across three intersecting disciplines: dermatological surgery (excision and complex reconstruction), dermatopathology (reading one's own frozen sections), and clinic-based laboratory management (running a cryostat and histology lab).[3]

Outside the US, the British Society for Dermatological Surgery (BSDS) and the Australasian College of Dermatologists (ACD) run Mohs training pathways within dermatology, and European and Asian colleges are building equivalents. The unifying rule — and the line examiners want — is that the surgeon who reads the slides is the surgeon who operated; delegating slide reading to a remote pathologist is not Mohs.[9]

The cost question — more per procedure, less over a lifetime

Mohs is more expensive per procedure than standard excision — extra surgeon, histotechnician, on-site laboratory and patient time — but cost-effective overall for high-risk tumours, because it avoids the downstream cost of recurrence surveillance, re-operation, and management of advanced recurrent disease. Systematic reviews report that for tumours meeting the Appropriate Use Criteria, Mohs is cost-neutral or cost-saving versus standard excision plus the cost of recurrence, and its cost per quality-adjusted life-year (QALY) is highly favourable.[9]

The economics are clearest at the two extremes. For a low-risk nodular BCC on the trunk, standard excision is cheaper and cures equivalently. For a recurrent infiltrative BCC on the nose, Mohs is both more curative and, over a lifetime, less costly than serial re-excision. The AUC exist precisely to point the technique at the tumours where its margin benefit is worth its price.[9]

The high-yield points — what earns the marks

Ward-round test

Stem 1 — recurrent BCC on the nasal ala after standard excision (answer)

This is the canonical Mohs indication, and standard excision must not be repeated. The lesion sits in the H-zone (perinasal, nasal ala, free margin), it is recurrent, and infiltrative histology means subclinical extension well beyond the visible nodule. Mohs examines 100% of the margin en face, read by the operating surgeon, so it actually proves clearance where bread-loafing only sampled it. Quote a 94 to 96% five-year cure for recurrent BCC with Mohs, against roughly 80 to 85% for standard excision — the gap is widest exactly here.[1][6]

Stem 2 — the single defining feature examiners probe, and the trap (answer)

100% of the surgical margin examined on horizontal (en face) frozen sections, read by the surgeon who operated — same day. The trap is equating Mohs with frozen sections. A generic intra-operative frozen section is a representative vertical cut sent to a separate pathologist, sampling only a fraction of the margin; Mohs is complete circumferential and deep margin assessment (CCPDMA) of the entire true margin, read by the operating surgeon off a colour-coded map. Say Mohs is just frozen sections, and you fail the stem.[3][9]

Stem 3 — a slowly enlarging indurated plaque on the trunk, biopsy DFSP (answer)

Refer for Mohs — ideally slow-Mohs with CD34 immunostain — not wide local excision. DFSP infiltrates subcutaneous fat in a honeycomb lace of slender CD34-positive spindle cells that run far beyond the visible plaque, so even a 2 to 3 cm wide margin leaves historical local recurrence of 20 to 50%. Slow-Mohs with permanent paraffin sections and CD34 maps the true tentacled extent, drops recurrence to under 2 to 5%, and spares normal tissue — the modern standard of care.[6]

References

1. [1]Bittner GC, Cerci FB, Kubo EM, et al. Mohs micrographic surgery: a review of indications, technique, outcomes, and considerations. Anais Brasileiros de Dermatologia, 2021.PMID 33849752
2. [2]Owens WR, Quirarte DM, Gillipelli SR, et al. Lip Reconstruction. Seminars in plastic surgery, 2024.PMID 39697401
3. [3]Golda N, Hruza G. Mohs Micrographic Surgery. Dermatologic Clinics, 2023.PMID 36410982
4. [4]Marzuka AG, Book SE. Basal cell carcinoma: pathogenesis, epidemiology, clinical features, diagnosis, histopathology, and management. The Yale journal of biology and medicine, 2015.PMID 26029015
5. [5]Pulumati A, Algarin YA, Kim S, et al. 3D bioprinting: a review and potential applications for Mohs micrographic surgery. Archives of dermatological research, 2024.PMID 38698273
6. [6]Mullen JT, Feng L, Xing Y, et al. Dermatofibrosarcoma Protuberans: Wide Local Excision Versus Mohs Micrographic Surgery. Surgical oncology clinics of North America, 2016.PMID 27591501
7. [7]Lewis DJ, Sobanko JF, Etzkorn JR, et al. Merkel Cell Carcinoma. Dermatologic clinics, 2023.PMID 36410971
8. [8]Cline E, Papac N, McBride J, Collins L. Oral Mucosal Lentigo Maligna Treated With Mohs Micrographic Surgery. Dermatologic surgery, 2023.PMID 36946694
9. [9]Tierney EP, Hanke CW. Cost effectiveness of Mohs micrographic surgery: review of the literature. Journal of drugs in dermatology, 2009.PMID 19852120