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F E Mohs

Publications and source records attributed to F E Mohs.

At least 19 recordsLinked to original sources
PubMed1995

Freehand technique to harvest partial-thickness skin to repair superficial facial defects.

BACKGROUND: The freehand-scalpel technique to harvest skin for grafting is a forgotten surgical art. Modern facial surgeons prefer to use local skin flaps or Wolfe-type full grafts to repair facial defects. OBJECTIVE: To determine the relative merits and cosmetic results of freehand skin grafts to cover facial defects following Mohs surgery. METHODS: We used the freehand-scalpel technique to harvest skin from the periauricular region of the neck and cheek, and other sites. After a local anesthetic is injected the number 15 or 10 blade is used to harvest skin by sequential tangential incisions. The average dermal thickness was about 1.0 mm. To improve cosmetic appearance, the overall shape and thickness of the graft was contoured during harvesting to fit cosmetic unit or facial line. RESULTS: For more than 5 years we have used the freehand technique to repair superficial facial defects of the nose, ear, scalp, temple, forehead, and other nonhead sites. A total of 65 freehand procedures were performed to repair facial defects. The distribution of the anatomic sites and sizes are presented. The size ranged from less than 1 cm to greater than 5 cm in diameter. Three typical cases are presented to illustrate the gratifying results that can be obtained with this technique. CONCLUSIONS: In selected sites and patients, the freehand graft is a rapid and convenient method of harvesting skin. When harvested from the preauricular cheek and subauricular neck, the graft is a good match to cover sun-exposed defects of the nose and ear. The major advantages of the freehand technique are that: 1) it expands the number of potential donor sites from which to select the most compatible skin to cover facial defects; 2) it allows the surgeon to efficiently configure the graft to the desired shape and depth to conform to the cosmetic unit or defect that is being reconstructed; 3) it does not require a dermatome or other specialized instrument to perform; and 4) it achieves wound repair with good appearance and function. The freehand partial-thickness skin graft has become our preferred method of grafting superficial facial defects.

Ear↗
PubMed1992

Mohs micrographic surgery for penile tumors.

The advantages of the total microscopic control of excision that is provided by Mohs micrographic surgery often justify consideration of this modality in neoplasms of the penis. The excision in successive layers with complete microscopic scanning of the entire underside of each horizontally cut layer assures eradication of the silent outgrowths that often extend well beyond the clinically visible and palpable borders of the cancer. With elimination of all ramifications, the excisions are abruptly stopped, and removal of a substantial surgical margin of normal tissue is obviated. Other advantages are the absence of need for general anesthesia and the fact that most patients remain ambulatory.

Adult↗
PubMed1991

Metastatic basal cell carcinoma: report of twelve cases with a review of the literature.

Metastatic basal cell carcinoma was found in 12 patients at the University of Wisconsin Mohs Surgery Clinic during the period 1936 to 1989. All patients were white men. The time of onset of the primary tumor ranged from childhood to 71 years. Eleven patients had previous treatment for basal cell carcinoma; two patients had received x-ray radiation to the face for teenage acne. The locations of the primary basal cell carcinomas were the face (n = 10), back (n = 1), and arm (n = 1). The primary tumors ranged from 3.6 x 3.0 to 20.0 x 7.0 cm. The interval from onset to the first sign of metastases ranged from 7 to 34 years. In all cases, the primary tumor was histologically identical to the metastatic lesion. Perineural extension of the basal cell carcinoma in the primary lesion was found in five cases. Regional lymph nodes were the most frequent site of metastasis. Treatment consisted of a combination of surgery, radiation, and chemotherapy. Only two patients survived more than 5 years after surgical treatment. One patient has survived 25 years and is still alive.

Aged↗
PubMed1991

Cylindroma treated by Mohs micrographic surgery.

Cylindroma, a rare benign adnexal neoplasm, may occur in areas in which simple excision is either not possible or severely disfiguring. We present a case of cylindroma that was treated by Mohs micrographic surgery. Postsurgical evaluation of the tumor showed that the tumor had invaded a larger area than was initially suspected based on clinical examination alone.

Aged↗
PubMed1991

Malignant cylindroma of the scalp.

Malignant cylindroma may develop via malignant transformation of cylindroma in rare instances or may develop de novo in others. We present a case of malignant cylindroma located on the left parietal-occipital scalp that was treated twice by Mohs micrographic surgery in an attempt to excise the tumor completely and to minimize the excision of normal tissue. Our case is the sixteenth reported case of malignant cylindroma in the world literature.

Aged↗
PubMed1991

Excision of exposed cartilage for management of Mohs surgery defects of the ear.

Cartilage of the ear is often exposed during Mohs surgical procedures. Fenestration of the cartilage with a skin punch has been recommended to stimulate granulation tissue where the perichondrium has been destroyed. This article describes an alternative method--the excision of a window through the exposed cartilage, fully exposing the perichondrium on the other side of the cartilage. This promotes the rapid healing by second intention or provides a vascular bed for immediate skin grafting. Also, aggressive excision of nonviable cartilage helps prevent chondritis or perichondritis.

Ear Cartilage↗
PubMed1991

Power drills to fenestrate exposed bone to stimulate wound healing.

Power drills can be used to stimulate the formation of granulation tissue over exposed cortical bone. These tools allow for the rapid fenestration and selective abrasion of large areas of exposed bone; fenestration and abrasion create the multiple bleeding points essential for the production of granulation tissue. The granulation tissue thus produced is allowed to grow out through the holes to cover bone. This procedure can be performed in an outpatient setting, usually without the need for either local or general anesthesia; it is particularly useful for patients considered to be poor risks for general anesthesia. Healing by granulation tissue is a somewhat slow process, but it has a high success rate, causes few complications, and produces very good cosmetic results. Two cases illustrate the method of fenestration of exposed cranial bone to stimulate granulation tissue. Specific instructions describe the needed care of exposed bone.

Aged↗
PubMed1990

Mohs micrographic surgery fixed-tissue technique for melanoma of the nose.

Mohs micrographic surgery, fixed-tissue technique, for excision of nasal melanoma provides three important benefits: 1) assurance of eradication of the main mass along with its "silent" contiguous outgrowths, 2) safe management of non-contiguous satellites too small to be visible initially, and 3) safe sparing of maximal amounts of surrounding normal tissues. These benefits are achieved because all incisions are through chemically fixed (killed) tissue, eliminating the danger of disseminating the highly transplantable melanoma cells and permitting the excision of successive layers for microscopic scanning of their undersurfaces by the systematic use of frozen sections. The process is continued to the termination of each ramification. There is no need to remove a wide margin of normal tissue as is customary with conventional surgery. Clinically invisible satellites are not moved or disturbed and can be removed safely by the same method if they appear. The reliability of the method is manifested by the 62.5% 5-year cure in a series of 10 consecutive patients, all of whom had no local recurrence after micrographic surgery.

Female↗
PubMed1990

Nasal tip reconstruction: the horizontal "J" rotation flap using skin from the lower lateral bridge and cheek.

The horizontal "J" flap is a rotation flap that uses skin from the lower lateral bridge and cheek to repair full-thickness skin defects of the nasal tip. Pertinent anatomic morphologic characteristics of the nasal tip skin that contribute to the unique character of the nose are discussed. The example defects presented resulted from the excision of skin cancers using micrographic surgery. Nasal tip reconstruction, using adjacent skin based on the nasal anatomic subunit principle, results in superior aesthetic repairs.

Basal Cell Carcinoma↗
PubMed1990

Anatomic rubber stamps of the face and body to document procedures in dermatologic surgery: one picture is worth a thousand words.

Representations of the anatomic surface location of cutaneous lesions and the surgical procedures performed on these lesions can be transferred to the medical charts using simple anatomic rubber stamps (ARS) of the body. The technique is exemplified with symbols to represent surgical excision, chemical face peel, dermabrasion, micrographic surgery, and the harvesting of flaps and grafts. ARS are also useful in liposuction surgery, punch grafts for pitted facial scars, hair transplantation, sclerotherapy, laser surgery, and other cosmetic dermatologic procedures. ARS are particularly valuable in micrographic surgery for skin cancer because they help document the depth and breadth of cancer invasion and aid in the follow-up of recurrent skin cancer, especially when defects are reconstructed.

Basal Cell Carcinoma↗
PubMed1989

Mohs micrographic surgery. A historical perspective.

Excising cancer in successive layers and examining the entire underside of each layer in the microscope by the systematic use of frozen sections ensure eradication of the neoplasm, including its "silent" outgrowths, and this is accomplished with the maximal sparing of normal tissue. Fresh-tissue micrographic surgery is used for most cancers, but the fixed-tissue technique is safer for melanomas because all incisions are made through fixed (killed) tissues, avoiding the danger of disseminating highly transplantable melanoma cells from transecting silent outgrowths or clinically invisible satellites. Although the essential concept was very simple, more than a half century of continuing development was required to bring the method to its present status; further progress is an exciting prospect.

Histological Techniques↗
PubMed1989

Mohs micrographic surgery for melanoma.

The results of multiple investigators have confirmed the value of Mohs surgery in the treatment of melanoma. In addition, these studies have contributed to our understanding of the biologic behavior of melanoma. The success of Mohs surgery confirms that melanoma grows in a contiguous fashion before it spreads systemically. It is known that once tumor breaks away from the main mass, trying to improve survival by increasing the extent of conventional surgery is often fruitless. Therefore, the goal of surgery is to remove all of the tumor, including the silent contiguous foci. If melanoma did not grow in a contiguous fashion before metastasis, the results of Mohs surgery would be inferior to wide excision, and higher local recurrences would be expected. Instead, the excellent results support the concept of contiguous tumor growth. Satellites and in-transit metastases that appear later may be removed with the fixed-tissue technique. We have also learned that melanoma sends out silent contiguous extensions, necessitating excision of some normal-appearing skin. The width of those extensions is unrelated to the depth of the melanoma. The value of Mohs surgery is the ability to identify these extensions microscopically and to excise tumor-bearing tissue while sparing normal skin. In fact, Mohs surgery often spares a diameter of 1.8 cm or more when compared with standard surgery, a distinct advantage to patients whose melanomas are on the head, neck, hands, feet, or genitalia or in patients whose melanoma has indistinct clinical margins and would require an even wider margin of normal skin when using standard surgical techniques. We now have long-term results from large numbers of patients--confirmed by multiple investigators and data--to support the concept of Mohs surgery for melanoma. This information emphasizes the important role that Mohs micrographic surgery plays in the treatment of melanoma.

Frozen Sections↗
PubMed1988

Fixed-tissue micrographic surgery for melanoma of the ear.

Auricular melanoma poses two primary problems: eradicating the primary neoplasm and managing potential satellites; both must be solved without spilling the highly transplantable cells. A secondary problem is the need to spare the cartilaginous framework that gives shape to the ear. With fixed-tissue micrographic surgery, all incisions are made through fixed (killed) tissue as successive layers of tissue are conservatively removed for microscopic scanning of their undersurfaces by the systematic use of frozen sections. Because no incisions are made through live tissue, no melanoma cells are spilled during the excision of the neoplasm and its "silent" outgrowths. Satellites too small to be seen are not moved or disturbed and can be removed as they appear. The reliability of the method is indicated by a five-year cure rate of 75% in a series of 17 patients.

Ear Cartilage↗
PubMed1986

Micrographic surgery for the microscopically controlled excision of eyelid cancers.

Because it allows for the total microscopic control of excision, micrographic surgery is a solution to the problem of determining the exact extent of cancers of the eyelids. The control of excision is achieved by removing successive layers of the affected tissues and microscopically examining the entire undersurface of each layer by the systematic use of frozen sections. The reliability of the method is attested by the five-year cure rates of 99% in 1,773 cases of basal cell carcinoma and of 98.1% in 213 cases of squamous cell carcinoma of the eyelids. Also important is the minimal removal of uninvaded tissue that is feasible because of the precise localization and selective removal of the clinically unpredictable cancerous outgrowths. This saving of normal tissue permits some innovative techniques of wound management.

Basal Cell Carcinoma↗
PubMed1986

Micrographic surgery for satellites and in-transit metastases of malignant melanoma.

Satellites and in-transit metastases do not always forebode the systemic dissemination of malignant melanoma. Five patients with varying numbers of these lesions were successfully treated with the fixed-tissue technique of micrographic surgery. This method permits the excision of these embolic foci with a minimal risk of further dissemination. It is important that the lesions be detected and removed as early as possible.

Aged↗
PubMed1986

Chromoblastomycosis treated by Mohs micrographic surgery.

Mohs micrographic surgery has been used to treat a variety of skin cancers with excellent results. We present a case where the application of this technique was used effectively to treat a lesion of localized cutaneous chromoblastomycosis. One year following the surgery no recurrence has occurred.

Aged↗