Journal Club

This large retrospective study evaluated clinical outcomes of high-risk cutaneous squamous cell carcinoma (cSCC) treated with Mohs micrographic surgery alone, without adjuvant therapy. The study analyzed local recurrence, nodal metastasis, and disease-specific death rates. Results demonstrated excellent outcomes for the majority of high-risk cSCC cases treated with Mohs alone, though a subset of tumors with multiple high-risk features showed higher rates of adverse outcomes. The findings support Mohs surgery as definitive treatment for most high-risk cSCC and help identify patients who may benefit from closer surveillance or adjuvant therapy.

Mohs surgery alone achieves excellent local control for the majority of high-risk cSCC, with low recurrence and metastasis rates.

Tumors with multiple concurrent high-risk features (PNI, poor differentiation, immunosuppression) carry higher risk of adverse outcomes even after Mohs.

These outcome data support risk-stratified surveillance protocols: closer follow-up for tumors with multiple high-risk features.

This retrospective cohort study compared survival outcomes of Merkel cell carcinoma (MCC) treated with Mohs micrographic surgery versus wide local excision (WLE). The analysis evaluated local recurrence, distant recurrence, and overall survival. Results showed comparable or superior outcomes with Mohs compared to WLE, suggesting that Mohs is a viable surgical approach for MCC, particularly for tumors where tissue conservation is important. The study contributes to the growing evidence supporting Mohs as an alternative to wide excision for this aggressive neuroendocrine carcinoma.

Mohs surgery demonstrates comparable or superior local recurrence rates versus WLE for Merkel cell carcinoma.

Mohs offers the advantage of complete margin assessment with maximal tissue conservation in MCC.

MCC treatment decisions should integrate surgical approach with sentinel lymph node biopsy and consideration of adjuvant therapy.

This national cohort analysis evaluated the role of sentinel lymph node biopsy (SLNB) in patients with clinical stage IIB/C cutaneous melanoma. The study examined whether SLNB provides prognostic and therapeutic benefit in this higher-risk melanoma population, analyzing recurrence-free survival and overall survival outcomes. The data contribute to the ongoing discussion about optimal staging procedures for intermediate to thick melanomas.

SLNB provides important prognostic information for clinical stage IIB/C melanoma patients, guiding adjuvant therapy decisions.

Completion lymph node dissection is increasingly replaced by adjuvant immunotherapy in SLN-positive patients.

The role of SLNB is evolving with the availability of effective adjuvant checkpoint inhibitor therapies.

This study compared Mohs micrographic surgery (MMS) with wide local excision (WLE) for the treatment of extramammary Paget's disease (EMPD). MMS demonstrated lower recurrence rates than WLE while preserving more tissue, supporting its role as a preferred surgical approach for this challenging condition.

Mohs surgery offers superior margin control and lower recurrence rates compared to WLE for EMPD.

Given the subclinical spread typical of EMPD, complete margin assessment with MMS is particularly advantageous.

This study evaluated the indications, outcomes, and decision-making considerations for Mohs surgery in patients older than 85 years with nonmelanoma skin cancer. The findings demonstrated that Mohs surgery remains safe and effective in elderly patients when appropriately indicated, though careful patient selection considering life expectancy and comorbidities is essential.

Advanced age alone should not preclude Mohs surgery; treatment decisions should incorporate tumor characteristics, patient comorbidities, and life expectancy.

Mohs surgery in elderly patients can achieve excellent cure rates with minimal morbidity when cases are appropriately selected.

This study evaluated recurrence rates after globe-sparing surgery for ocular adnexal malignancies, with particular relevance to Mohs micrographic surgery. The data supported that globe-sparing approaches can achieve acceptable oncologic outcomes while preserving the eye, though close follow-up is essential.

Globe-sparing surgery for periocular malignancies can achieve good oncologic outcomes while preserving vision and ocular function.

Long-term surveillance is critical after globe-sparing surgery for ocular adnexal tumors due to the risk of local recurrence.

This study by Thompson et al. evaluated the rate of residual tumor found at the time of definitive excision after diagnostic biopsy in cutaneous malignancies. The findings quantified how often residual tumor remains at the biopsy site and its implications for surgical planning and margin assessment.

Residual tumor is frequently present at biopsy sites of cutaneous malignancies, supporting the need for definitive surgical treatment even after apparently complete biopsies.

Biopsy technique and tumor type influence the likelihood of residual tumor, which should be considered in surgical planning.

This study demonstrated that Mohs micrographic surgery for Merkel cell carcinoma achieves lower local recurrence rates compared to alternative surgical approaches. The complete peripheral and deep margin assessment inherent to Mohs provides a significant oncologic advantage for this aggressive neuroendocrine tumor.

Mohs surgery for MCC significantly reduces local recurrence risk through complete circumferential margin assessment.

MMS should be considered as a primary surgical option for MCC, particularly for tumors in anatomically sensitive areas.

This study compared Mohs surgery with wide local excision for primary high-stage cutaneous squamous cell carcinoma, evaluating recurrence rates, survival, and margin status. Mohs surgery demonstrated favorable outcomes with lower recurrence rates and better tissue conservation, supporting its use even for high-stage cSCC.

Mohs surgery achieves lower recurrence rates than wide local excision for high-stage cSCC while preserving more tissue.

High-stage cSCC is an appropriate indication for Mohs surgery, particularly on the head and neck where tissue conservation is paramount.

This systematic review and meta-analysis compared recurrence rates of high-risk keratinocyte carcinomas (BCC and SCC) treated with complete margin assessment (CMA, as in Mohs micrographic surgery) versus standard excision with sectional assessment (SA). The analysis demonstrated significantly lower recurrence rates with CMA across all high-risk tumor categories, reinforcing the rationale for Mohs surgery in managing high-risk skin cancers. The study provides Level 1 evidence supporting NCCN guidelines recommending CMA for keratinocyte carcinomas with high-risk features.

Complete margin assessment (Mohs) yields significantly lower recurrence rates than sectional assessment for high-risk keratinocyte carcinomas.

This meta-analysis provides Level 1 evidence supporting NCCN guidelines for CMA in high-risk BCC and SCC.

The recurrence benefit of CMA is consistent across all high-risk tumor subtypes and anatomical locations.

This comprehensive 17-year retrospective analysis of 1,421 Mohs surgery cases evaluated concordance between Mohs surgeons' intraoperative frozen section interpretations and independent dermatopathologist review. The study found a very high rate of agreement, with discordance occurring in only a small percentage of cases, primarily in subtle histologic patterns. The analysis provides robust quality assurance data supporting the reliability of Mohs surgeons' slide interpretation and highlights specific tumor types where enhanced vigilance is warranted.

Mohs surgeon frozen section interpretation shows >97% concordance with independent dermatopathologist review across 1,421 cases.

Discordance is most common with subtle histologic patterns such as desmoplastic or perineural invasion patterns.

These findings support quality assurance protocols including periodic concordance audits in Mohs surgery practices.

This case report describes cytokeratin-derived amyloid deposits that can mimic invasive basal cell carcinoma on Mohs frozen sections. The amyloid appears as basophilic aggregates that may be misinterpreted as tumor nests, potentially leading to unnecessary additional stages. Recognition of this pitfall is essential for accurate intraoperative interpretation and avoiding over-treatment.

Cytokeratin-derived amyloid can appear as basophilic aggregates mimicking BCC tumor nests on frozen sections.

Congo red staining can help distinguish amyloid deposits from true tumor when diagnostic uncertainty exists.

Awareness of this artifact is critical to prevent unnecessary additional Mohs stages.

This study surveyed immunohistochemistry (IHC) utilization patterns in Mohs micrographic surgery, examining which stains are used most frequently, for which tumor types, and how IHC impacts surgical outcomes. The analysis revealed increasing adoption of IHC in Mohs practice, particularly MART-1/MelanA for melanoma, cytokeratin stains for poorly differentiated SCC, and BerEP4 for morpheaform BCC. The study provides evidence-based guidance on when IHC adds clinical value versus standard H&E-only interpretation.

IHC use in Mohs surgery is increasing, with MART-1/MelanA, cytokeratins, and BerEP4 as the most commonly used stains.

MART-1 immunostaining improves margin assessment accuracy for melanoma-in-situ and lentigo maligna treated with Mohs.

IHC is most valuable for tumors with subtle infiltrative patterns where H&E interpretation alone may be insufficient.

This study compared narrow versus wide initial margin protocols in Mohs micrographic surgery and their impact on the number of stages, tissue conservation, and cure rates. Results showed that narrow margins can be effective while preserving more tissue, though wider margins may reduce the number of stages required for certain tumor types.

Narrow initial excision margins in Mohs surgery can conserve tissue without compromising cure rates for well-defined tumors.

Wider initial margins may be appropriate for aggressive or poorly defined tumors to reduce the total number of Mohs stages.

This study examined the clinical significance of anticipated versus unanticipated incomplete excisions during Mohs micrographic surgery. Unanticipated positive margins were associated with more aggressive tumor biology and required additional stages, highlighting the need for careful preoperative assessment and margin planning.

Unanticipated positive margins in Mohs surgery may indicate more aggressive tumor behavior and should prompt careful re-evaluation.

Thorough preoperative clinical assessment helps predict subclinical tumor extension and reduce unanticipated incomplete excisions.

This study analyzed histologic margin status as a predictor of outcomes in cutaneous squamous cell carcinoma. The analysis demonstrated that positive or close margins after excision are significant predictors of local recurrence and adverse outcomes. The findings support the importance of achieving clear surgical margins and provide evidence for re-excision or Mohs surgery when margins are compromised.

Positive histologic margins after SCC excision significantly increase the risk of local recurrence.

Close margins (<1mm) also carry elevated recurrence risk and may warrant re-excision or Mohs conversion.

Complete margin assessment via Mohs surgery eliminates margin status uncertainty in high-risk SCC.

This concordance study by Juhasz et al. examined the agreement between clinical margin estimation and final pathological margins in cSCC excisions. The findings revealed that clinical margins frequently underestimate true tumor extent, reinforcing the value of margin-controlled excision techniques.

Clinical margin estimation frequently underestimates true pathological tumor extent in cSCC.

Margin-controlled excision techniques like Mohs surgery are superior to clinical estimation for ensuring complete tumor removal.

This national Medicare trend analysis documented the growing adoption of immunohistochemistry (IHC) by Mohs surgeons for margin assessment. The data showed a significant increase in IHC utilization over time, reflecting evolving practice patterns and the expanding role of IHC in Mohs surgery for melanoma and other tumors.

IHC utilization by Mohs surgeons has increased substantially, particularly for melanoma margin assessment with MART-1 and SOX-10.

The growing adoption of IHC reflects the expanding scope of Mohs surgery beyond traditional NMSC indications.

This study catalogued and characterized histologic artifacts and mimickers encountered during Mohs frozen section interpretation. These 'histologic hitchhikers' include various structures and artifacts that can be confused with tumor, potentially leading to false-positive margin readings and unnecessary additional stages. The study provides a visual reference guide for Mohs surgeons to improve frozen section interpretation accuracy.

Common histologic mimickers in Mohs include follicular structures, eccrine glands, and inflammatory infiltrates that can mimic BCC.

Awareness of tissue processing artifacts and normal anatomical structures is essential for accurate frozen section interpretation.

This visual reference guide can serve as a quality improvement tool for Mohs surgeons and trainees.

This review examined the technique and interpretation of MART-1 immunostaining on frozen sections during Mohs surgery for melanoma. The paper provided practical guidance on staining protocols, interpretation pitfalls, and clinical decision-making based on MART-1 staining patterns.

MART-1 staining on frozen sections is essential for accurate margin assessment during Mohs surgery for melanoma.

Familiarity with MART-1 staining artifacts and interpretation challenges is critical to avoid both false-positive and false-negative margin assessments.

This study evaluated the concordance between Mohs surgeons and dermatopathologists in assessing melanoma margin status on frozen sections. High concordance rates were observed, supporting the competency of Mohs surgeons in independent melanoma margin interpretation when using appropriate immunostains.

Mohs surgeons demonstrate high concordance with dermatopathologists in melanoma margin assessment on immunostained frozen sections.

This concordance data supports the competency of fellowship-trained Mohs surgeons to independently interpret melanoma margins.

This study developed and evaluated a deep learning algorithm for automated segmentation of basal cell carcinoma on Mohs frozen section slides. The AI model demonstrated high accuracy in identifying tumor regions, showing potential for assisting Mohs surgeons in margin assessment and reducing interpretation time.

Deep learning algorithms can accurately segment BCC on Mohs frozen sections, offering potential as a computer-aided detection tool.

AI-assisted margin assessment may improve efficiency and reduce diagnostic errors during Mohs surgery for BCC.

This systematic review and meta-analysis evaluated outcomes and prognostic factors for cutaneous squamous cell carcinoma with bone invasion. The analysis demonstrated that bone invasion represents a significant adverse prognostic factor associated with higher rates of recurrence, metastasis, and disease-specific mortality. The findings support aggressive management including wide surgical excision or Mohs with bone assessment, and consideration of adjuvant therapy.

Bone invasion in cSCC is associated with significantly worse prognosis including higher recurrence and metastasis rates.

Complete bone margin assessment may require specialized techniques beyond standard Mohs frozen section processing.

Adjuvant radiation therapy should be considered for cSCC with bone invasion given the elevated recurrence risk.

This study evaluated the role of adjuvant radiation therapy for basal cell carcinoma with perineural invasion (PNI). Findings suggested that radiation may improve local control in BCC with PNI, particularly for large-caliber nerve involvement, though patient selection remains important.

Adjuvant radiation should be considered for BCC with large-caliber perineural invasion to reduce local recurrence risk.

Small-caliber, incidental PNI in BCC may not require adjuvant radiation, and clinical judgment should guide treatment decisions.

This study investigated the prognostic significance of different perineural invasion (PNI) patterns in cutaneous squamous cell carcinoma, specifically comparing extensive PNI versus large-caliber nerve involvement as predictive factors for adverse outcomes. The analysis demonstrated that both extensive PNI and large-caliber nerve involvement are independent predictors of local recurrence and metastasis, but extensive PNI pattern may carry even greater prognostic weight. The findings have important implications for staging, surgical planning, and adjuvant therapy decisions in cSCC with PNI.

Both extensive PNI and large-caliber nerve involvement independently predict worse outcomes in cSCC.

Extensive PNI pattern may carry greater prognostic significance than nerve caliber alone for predicting metastasis.

Detailed PNI characterization in pathology reports is essential for guiding adjuvant therapy decisions and surveillance intensity.

This multi-factor analysis identified clinical and histopathologic variables associated with poor outcomes in cutaneous squamous cell carcinoma. The study evaluated multiple risk factors simultaneously to determine which combinations carry the highest prognostic significance, informing risk stratification and management decisions for cSCC.

Multiple concurrent high-risk features in cSCC compound the risk of recurrence and metastasis.

Tumor thickness >6mm, poor differentiation, and perineural invasion are among the strongest independent predictors of poor outcomes.

Multi-factor risk assessment should guide surveillance intensity and adjuvant therapy considerations in cSCC.

This study examined the management approach and clinical outcomes for squamous cell carcinoma of the scalp, a location associated with higher recurrence and metastasis rates. The findings emphasized the importance of complete margin assessment and consideration of adjuvant therapy for high-risk scalp SCC.

Scalp SCC carries higher rates of recurrence and metastasis compared to other anatomic sites and warrants aggressive surgical management.

Mohs surgery with complete margin assessment is particularly valuable for scalp SCC given the elevated risk of subclinical extension.

This study evaluated the safety of watchful waiting after biopsy for SCC in situ, examining recurrence and progression rates in patients who did not undergo immediate definitive treatment. The results provided data on the natural history of incompletely excised SCCis and guided decision-making about observation versus treatment.

Watchful waiting after biopsy of SCC in situ may be acceptable in select low-risk cases, though close monitoring is essential.

Definitive treatment of SCCis should remain the standard approach, with observation reserved for patients in whom surgical morbidity outweighs oncologic risk.

This study compared the performance of various staging systems (AJCC, BWH, UICC) for cutaneous squamous cell carcinoma in predicting clinical outcomes. The analysis identified which staging system best stratifies patients by recurrence and metastatic risk, informing clinical decision-making and treatment planning.

The BWH staging system demonstrates superior prognostic discrimination for cSCC compared to AJCC in many studies.

Accurate staging of cSCC is essential for risk stratification and guides decisions about adjuvant treatment and surveillance intensity.

This study evaluated when radiologic imaging is indicated for high-risk cutaneous SCC and which modalities are most appropriate. The review provided evidence-based recommendations for imaging utilization based on tumor risk factors, clinical staging, and suspicion for nodal or distant metastasis.

Imaging for high-risk cSCC should be guided by specific clinical and histologic risk factors rather than applied routinely.

Ultrasound, CT, and PET/CT each have distinct roles in staging high-risk cSCC depending on the clinical scenario.

This study differentiated between satellitosis and in-transit metastasis in cutaneous squamous cell carcinoma, analyzing their distinct clinicopathologic features and prognostic implications. The findings provided clarity on the classification and management implications of these two forms of locoregional tumor spread.

Distinguishing satellitosis from in-transit metastasis in cSCC has important prognostic and staging implications.

Both satellitosis and in-transit metastasis indicate aggressive tumor biology and should prompt evaluation for systemic disease.

This study demonstrated that radiologic imaging aids in the management of high-risk cutaneous squamous cell carcinoma by detecting clinically occult nodal and distant metastases. Imaging-guided management led to changes in treatment plans for a significant proportion of patients with high-risk tumors.

Radiologic imaging in high-risk cSCC can detect occult metastases and lead to meaningful changes in management.

Appropriate imaging should be integrated into the workup of cSCC with high-risk features to optimize treatment planning.

This study evaluated oncologic outcomes for invasive SCC with a clinically resolved biopsy site managed with watchful waiting rather than immediate definitive excision. The data provided evidence on the safety of observation in select cases where the biopsy appeared to completely remove the tumor.

Watchful waiting may be an acceptable approach for select invasive SCCs with clinically resolved biopsy sites, though careful patient selection is critical.

Close clinical follow-up is mandatory when pursuing observation for invasive SCC to detect early recurrence.

This study evaluated the evidence for adjuvant radiation therapy in Merkel cell carcinoma, analyzing its impact on local recurrence, regional control, and overall survival. The review synthesized data from multiple studies to assess when adjuvant radiation provides benefit beyond surgery alone, considering factors such as tumor size, margin status, and nodal involvement.

Adjuvant radiation reduces local and regional recurrence in MCC, particularly for tumors with positive or close margins.

The benefit of adjuvant radiation is most pronounced for primary tumors >2 cm and those with nodal involvement.

Radiation field and dose protocols for MCC remain variable across institutions, highlighting the need for standardized guidelines.

This population-based study evaluated whether sentinel lymph node biopsy (SLNB) status improves adjuvant therapy decision-making in stage IIB/C melanoma. SLNB results provided meaningful prognostic stratification that influenced adjuvant treatment recommendations, supporting its routine use in this patient population.

SLNB provides valuable prognostic information that directly impacts adjuvant therapy decisions in stage IIB/C melanoma.

Routine SLNB should be strongly considered in stage IIB/C melanoma to guide personalized adjuvant treatment planning.

This study examined the impact of delayed postoperative radiation therapy on recurrence risk in Merkel cell carcinoma. Longer time intervals between surgery and initiation of adjuvant radiation were associated with increased recurrence rates, emphasizing the importance of timely adjuvant treatment.

Delayed initiation of adjuvant radiation therapy for MCC significantly increases local and regional recurrence risk.

Adjuvant radiation for MCC should be initiated as promptly as possible after surgical excision to optimize outcomes.

This phase 2 clinical trial (EMPOWER-CSCC-1) evaluated cemiplimab (Libtayo), an anti-PD-1 checkpoint inhibitor, in patients with advanced and metastatic cutaneous squamous cell carcinoma. The study demonstrated significant objective response rates and durable responses in patients with locally advanced and metastatic cSCC who were not candidates for curative surgery or radiation. These results led to FDA approval of cemiplimab as the first systemic therapy approved for advanced cSCC, leading to its FDA approval as the first systemic therapy for advanced cSCC.

Cemiplimab achieved ~47% objective response rate in advanced/metastatic cSCC, with durable responses in the majority of responders.

This trial established cemiplimab as the first FDA-approved systemic therapy for advanced cSCC not amenable to curative surgery or radiation.

The high mutation burden of cSCC underlies its responsiveness to immune checkpoint inhibition, with implications for patient selection.

This study examined whether prior radiotherapy to the tumor site increases the efficacy of cemiplimab in patients with locally advanced or metastatic cutaneous SCC. Results suggested that previous radiation may enhance immunotherapy response, potentially through radiation-induced immunogenic cell death and neoantigen exposure.

Prior radiotherapy may enhance the efficacy of cemiplimab in advanced cSCC through synergistic immunogenic effects.

This radiation-immunotherapy interaction should be considered when sequencing treatments for advanced cutaneous SCC.

This national cohort study evaluated how the sequencing of immunotherapy relative to surgery impacts outcomes in operable stage III melanoma. The analysis compared neoadjuvant versus adjuvant immunotherapy approaches and their effect on survival, recurrence, and surgical morbidity.

Sequencing of immunotherapy relative to surgery significantly impacts outcomes in operable stage III melanoma.

Neoadjuvant immunotherapy may offer survival advantages over adjuvant approaches in select stage III melanoma patients.

This NEJM randomized controlled trial evaluated adjuvant cemiplimab versus placebo in patients with high-risk cutaneous squamous cell carcinoma after surgery and optional radiation. Adjuvant cemiplimab demonstrated a significant reduction in disease recurrence, establishing adjuvant immunotherapy as a new option for high-risk cSCC.

Adjuvant cemiplimab significantly reduces disease recurrence in high-risk cSCC, changing the post-surgical management approach.

This RCT provides level 1 evidence supporting adjuvant immunotherapy for high-risk cSCC, changing the standard of care.

This study evaluated sonidegib, a hedgehog pathway inhibitor, for the treatment of advanced or recurrent basal cell carcinoma. The analysis assessed response rates, duration of response, and tolerability, providing updated efficacy data for this targeted therapy in BCC management.

Sonidegib demonstrates meaningful clinical efficacy in advanced or recurrent BCC that is not amenable to surgery or radiation.

Hedgehog pathway inhibitors remain an important systemic option for locally advanced BCC, though long-term tolerability should be monitored.

This study evaluated the use of neoadjuvant vismodegib (Hedgehog pathway inhibitor) to reduce tumor burden prior to Mohs micrographic surgery for periorbital basal cell carcinoma. The approach aimed to decrease defect size and minimize the need for complex periorbital reconstruction. The results demonstrated significant tumor volume reduction with neoadjuvant vismodegib, allowing more conservative surgical resection while maintaining oncologic outcomes.

Neoadjuvant vismodegib can significantly reduce BCC tumor volume, leading to smaller surgical defects in periorbital tumors.

This approach may simplify periorbital reconstruction by reducing defect complexity while maintaining clear margin rates.

Potential limitations include medication side effects, incomplete pathologic response, and the theoretical risk of skip areas.

This real-world analysis examined risk factors, treatment patterns, and outcomes in metastatic basal cell carcinoma, an exceedingly rare but serious clinical entity. The study identified tumor and patient characteristics associated with metastatic progression and evaluated treatment responses including hedgehog pathway inhibitors.

Metastatic BCC is rare but carries significant morbidity and mortality; risk factors include large tumor size, aggressive histology, and prior radiation.

Hedgehog pathway inhibitors represent an important therapeutic option for metastatic BCC in patients who are not surgical candidates.

This study provided updated clinical management guidelines for Gorlin syndrome (nevoid basal cell carcinoma syndrome), addressing surveillance, treatment of multiple BCCs, and genetic counseling. The guidelines incorporated recent evidence on hedgehog pathway inhibitors and emerging therapeutic approaches.

Gorlin syndrome patients require lifelong skin surveillance and a multi-modal approach to managing their high BCC burden.

Hedgehog pathway inhibitors have emerged as important therapeutic options for Gorlin patients with numerous or inoperable BCCs.

This study compared outcomes of Mohs micrographic surgery versus wide local excision (WLE) for Merkel cell carcinoma, focusing on local recurrence, metastatic rates, and overall survival. The meta-analysis included multiple retrospective studies and demonstrated that Mohs surgery achieves at least equivalent, and possibly superior, local control compared to WLE for MCC. The findings support including Mohs as a surgical option in MCC management guidelines, particularly when negative margins are difficult to achieve with standard excision.

Meta-analytic evidence supports Mohs surgery as achieving equivalent or superior local control versus WLE for MCC.

Complete margin assessment via Mohs may be particularly valuable in MCC given the tumor's tendency for subclinical extension.

Surgical approach selection for MCC should balance margin control with the need for sentinel lymph node biopsy staging.

This study compared survival outcomes for Merkel cell carcinoma (MCC) treated with Mohs micrographic surgery versus wide local excision. No significant difference in overall or disease-specific survival was found between the two surgical approaches, though Mohs offered tissue-sparing benefits.

Both Mohs surgery and wide local excision provide comparable survival outcomes for Merkel cell carcinoma.

Mohs surgery may be preferred for MCC in anatomically sensitive locations where tissue conservation is important.

This study assessed the utility of baseline imaging with ultrasound and FDG-PET/CT in newly diagnosed Merkel cell carcinoma. The findings demonstrated that baseline imaging can detect occult nodal and distant metastases, informing staging accuracy and treatment planning in MCC.

Baseline imaging with PET/CT and ultrasound in MCC can identify occult metastases and improve initial staging accuracy.

Early detection of nodal involvement through baseline imaging may alter management and improve outcomes in Merkel cell carcinoma.

This retrospective cohort study examined how facility characteristics (volume, type, academic affiliation) impact outcomes in Merkel cell carcinoma treatment. Higher-volume and academic centers were associated with improved survival, suggesting a benefit of centralized care for this rare malignancy.

Treatment at high-volume or academic centers is associated with better survival outcomes for Merkel cell carcinoma.

Referral to experienced multidisciplinary centers should be considered for MCC given the complexity of management.

This study developed a multivariable model and web-based calculator to predict recurrence risk in Merkel cell carcinoma after initial treatment. The tool incorporated clinical and pathologic variables to provide individualized risk estimates, aiding in surveillance planning and treatment decisions.

Individualized recurrence risk prediction tools for MCC can help tailor surveillance intensity and adjuvant treatment decisions.

Key predictors of MCC recurrence include tumor size, nodal status, and immunosuppression status.

This study developed a multivariable disease-specific prognostic model for Merkel cell carcinoma incorporating clinical, pathologic, and demographic variables. The model provides individualized prognostic estimates that can guide treatment intensity and surveillance planning for MCC patients.

A validated prognostic model for MCC can help individualize treatment intensity and surveillance based on patient-specific risk factors.

Integration of multiple clinical and pathologic variables improves prognostic accuracy beyond single-factor staging in MCC.

This multicenter cohort study examined the utility of sentinel lymph node biopsy in patients with thin (T1a) cutaneous melanomas. The study analyzed SLN positivity rates and recurrence outcomes in this low-risk population where SLNB is not routinely recommended. The findings help refine the indications for SLNB in thin melanoma and identify subsets that may benefit from more aggressive staging.

SLN positivity in T1a melanoma is very low (<5%), supporting current guidelines against routine SLNB in thin melanomas.

Select T1a features (mitotic rate, ulceration, lymphovascular invasion) may identify a subset warranting SLNB consideration.

The very low yield of SLNB in T1a melanoma must be balanced against procedural morbidity and cost.

This study evaluated the clinical integration of the 31-gene expression profile (GEP) test (DecisionDx-Melanoma) for cutaneous melanoma prognosis. The analysis assessed how GEP results correlate with clinical outcomes and how they can be integrated with traditional staging factors to improve risk stratification. The study examines the test's role in guiding surveillance intensity and adjuvant therapy discussions.

The 31-GEP test provides independent prognostic information beyond traditional AJCC staging factors in cutaneous melanoma.

GEP results may help identify patients who would benefit from enhanced surveillance or adjuvant therapy discussions.

Integration of molecular profiling with clinical staging remains an evolving area, with guidelines still being refined.

This study analyzed melanoma prognosis in patients with thicker tumors, focusing on staging accuracy and survival outcomes. The findings highlighted that Breslow thickness remains a critical prognostic factor, with survival rates declining significantly in tumors exceeding 4 mm, and emphasized the importance of accurate substaging for treatment planning.

Breslow thickness is a key determinant of melanoma survival, and accurate measurement is essential for staging and prognosis.

Patients with thick melanomas (>4 mm) require careful multidisciplinary evaluation for adjuvant therapy and surveillance.

This study evaluated outcomes of invasive melanoma of the head and neck treated with Mohs micrographic surgery. The analysis assessed local recurrence, disease-free survival, and melanoma-specific survival in this challenging anatomical region where tissue conservation is critical. Results demonstrated favorable outcomes with Mohs for head and neck melanoma, supporting its use as an effective surgical approach in this anatomically complex location.

Mohs surgery for head and neck melanoma demonstrates excellent local control with tissue-sparing benefits.

MART-1 immunostaining is essential for accurate margin assessment of melanoma during Mohs surgery.

Head and neck melanoma treated with Mohs should be combined with appropriate staging (SLNB) and surveillance protocols.

This study developed and validated an online risk calculator and nomogram to predict sentinel lymph node (SLN) positivity in patients with Merkel cell carcinoma (MCC). The tool incorporates multiple clinicopathologic variables including tumor size, anatomical location, and patient demographics to estimate the probability of nodal involvement. The calculator provides clinicians with a quantitative tool to guide SLNB decision-making and patient counseling for MCC, supporting personalized management approaches.

An externally validated nomogram can predict SLN positivity in MCC using readily available clinicopathologic variables.

Tumor size, anatomical location, and immunosuppression status are among the strongest predictors of nodal involvement in MCC.

This risk calculator can aid shared decision-making regarding SLNB in MCC, particularly for borderline cases.

This study evaluated compliance with NCCN guidelines for sentinel lymph node biopsy (SLNB) in Merkel cell carcinoma and identified predictors of SLNB utilization. Results showed suboptimal guideline adherence, with patient age, tumor size, and facility type influencing whether SLNB was performed.

SLNB utilization in MCC remains below NCCN guideline recommendations, particularly in elderly patients and community settings.

Efforts to improve SLNB compliance in MCC are warranted given its prognostic and therapeutic implications.

This population-based study compared sentinel lymph node biopsy utilization rates between melanoma patients treated with Mohs surgery versus wide local excision. The analysis revealed differences in SLNB rates between surgical approaches, raising questions about optimal staging integration in Mohs-treated melanoma patients. The findings highlight the importance of coordinating SLNB with surgical planning regardless of excision technique.

SLNB utilization rates may differ between Mohs surgery and WLE for melanoma, potentially reflecting practice pattern variations.

Coordinating SLNB with Mohs surgery requires careful procedural planning, ideally performing SLNB before or concurrent with Mohs.

All eligible melanoma patients should receive SLNB staging regardless of the primary excision method chosen.

This gap analysis identified significant underutilization of sentinel lymph node biopsy in early-stage melanoma patients who meet guideline criteria. The study characterized patient demographics and healthcare system factors associated with SLNB omission and highlighted opportunities to improve guideline adherence.

SLNB is underutilized in early-stage melanoma despite guideline recommendations, particularly among older patients and in non-academic settings.

Targeted educational initiatives may help close the gap between guideline recommendations and actual SLNB utilization rates.

This study performed an external validation of a melanoma sentinel lymph node metastasis risk prediction tool. The validated tool demonstrated good discrimination in predicting sentinel node positivity, supporting its clinical use for informed decision-making about SLNB in melanoma patients.

Validated risk prediction tools can help clinicians and patients make more informed decisions about whether to proceed with SLNB.

External validation confirmed that the melanoma SLNB risk tool performs well across diverse patient populations.

This study evaluated the relationship between excision margin size and local recurrence risk in T1a melanoma located near critical anatomic structures. The findings supported that narrower margins may be acceptable for thin melanomas in cosmetically or functionally sensitive areas without significantly increasing recurrence risk.

Narrower excision margins for T1a melanoma near critical structures do not appear to significantly increase local recurrence rates.

Margin decisions for thin melanomas at sensitive anatomic sites should balance oncologic safety with functional and cosmetic preservation.

This study by Abrantes et al. reviewed the surgical approach to melanoma in situ of the lentigo maligna subtype, focusing on margin management and recurrence patterns. The paper highlighted the challenges of subclinical extension in lentigo maligna and supported staged excision techniques including Mohs surgery with melanocyte-specific immunostains.

Lentigo maligna frequently extends beyond clinically apparent borders, making margin-controlled excision techniques essential.

Mohs surgery with MART-1 or other melanocyte immunostains improves margin accuracy and reduces recurrence in lentigo maligna.

This study evaluated the use of Mohs micrographic surgery for invasive cutaneous melanoma, analyzing cure rates, recurrence patterns, and outcomes compared with standard wide local excision. The data supported Mohs surgery as a viable option for melanoma, particularly at sites where tissue preservation is critical, with comparable oncologic outcomes.

Mohs surgery for invasive melanoma demonstrates comparable oncologic outcomes to wide local excision with superior tissue conservation.

MMS is especially advantageous for melanoma on the head and neck where standard excision margins would result in significant morbidity.

This 10-year retrospective study examined excision margins achieved by Mohs MMS for melanoma in situ of the head and neck, an area particularly prone to subclinical extension. Results informed optimal margin guidelines and demonstrated that Mohs provides reliable margin clearance for head and neck melanoma in situ.

Standard 5-mm margins may be insufficient for melanoma in situ on the head and neck due to significant subclinical extension.

Mohs surgery with melanocyte immunostains offers superior margin assessment for head and neck melanoma in situ.

This study by Fernung et al. evaluated the rate of melanoma upstaging (increased T-stage) at definitive excision compared to the initial biopsy diagnosis. The low upstaging rate observed provided reassurance regarding the reliability of initial biopsy staging for treatment planning in most melanoma cases.

Melanoma upstaging at definitive excision is relatively uncommon, supporting the reliability of initial biopsy for staging and management decisions.

Despite the low upstaging rate, complete excision with adequate margins remains important for accurate final pathologic staging.

This updated analysis reviewed recommended surgical margins for non-melanoma skin cancers, synthesizing data from multiple studies on margin adequacy for BCC and SCC. The review provided evidence-based guidance on optimal excision margins to balance complete tumor clearance with tissue conservation.

Standard surgical margins for NMSC should be guided by tumor type, histologic subtype, and anatomic location.

Margin-controlled techniques like Mohs surgery remain the gold standard for high-risk NMSC when complete margin assessment is needed.

This phase II trial evaluated the combination of a PAI-1 inhibitor (TM5614) with nivolumab in patients with anti-PD1 refractory melanoma. The study explored whether PAI-1 inhibition could overcome immune checkpoint therapy resistance, with preliminary results showing potential benefit in a subset of patients.

PAI-1 inhibition combined with nivolumab shows preliminary evidence of activity in anti-PD1 refractory melanoma.

Novel combination strategies targeting the tumor microenvironment may help overcome immunotherapy resistance in advanced melanoma.

This study examined the optimal timing of wide local excision (WLE) relative to sentinel lymph node biopsy (SLNB) in melanoma management. The analysis assessed whether performing WLE before, simultaneously with, or after SLNB impacts oncologic outcomes and surgical planning.

The timing of WLE relative to SLNB does not appear to significantly impact oncologic outcomes in melanoma.

Simultaneous WLE and SLNB is efficient and can reduce the number of surgical procedures without compromising staging accuracy.

This study evaluated the use of Mohs micrographic surgery for the treatment of nail unit melanoma, analyzing surgical outcomes, margin clearance rates, and digit preservation. The findings supported Mohs as a tissue-sparing alternative to amputation for select nail unit melanomas.

Mohs surgery for nail unit melanoma can achieve complete margin clearance while potentially avoiding digit amputation.

Careful patient selection and expertise in nail unit anatomy are essential for successful Mohs treatment of subungual melanoma.

This study assessed interrater and intrarater reliability of Mohs surgeons in interpreting MART-1 immunostained frozen sections for melanoma margin evaluation. The findings quantified agreement levels and identified areas of interpretive uncertainty, informing quality improvement and training efforts.

Mohs surgeon interpretation of MART-1 frozen sections shows good but imperfect interrater reliability, highlighting the need for standardized training.

Intrarater reliability is generally higher than interrater reliability, suggesting individual consistency but potential for systematic differences between surgeons.

This study compared outcomes of Mohs surgery for melanoma performed with and without MART-1 immunostains. Use of MART-1 was associated with improved margin assessment accuracy and may reduce recurrence rates, supporting routine use of melanocyte immunostains in Mohs for melanoma.

MART-1 immunostaining during Mohs surgery for melanoma improves margin assessment accuracy and is associated with better outcomes.

Routine use of melanocyte immunostains should be considered standard practice when performing Mohs for melanoma.

This study examined the clinical significance and prognostic implications of tumor upstaging in invasive melanoma, where definitive excision reveals a higher T-stage than the initial biopsy. The analysis addressed how upstaging affects management decisions including the need for SLNB and adjuvant therapy.

Melanoma upstaging at definitive excision can alter management including SLNB candidacy and adjuvant treatment eligibility.

Clinicians should be prepared to re-evaluate the treatment plan when upstaging occurs after initial melanoma biopsy.

This study demonstrated that nevus-associated acral melanoma has lower rates of recurrence and mortality compared to de novo acral melanoma. The findings suggest that the biologic behavior and prognosis of acral melanoma may differ based on its association with a precursor nevus.

Nevus-associated acral melanoma carries a better prognosis than de novo acral melanoma, with lower recurrence and mortality rates.

The distinction between nevus-associated and de novo acral melanoma may have implications for prognostic counseling and surveillance intensity.

This nationwide population-based cohort study of 1,118 patients evaluated local recurrence and metastasis rates for atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS). The study provided robust epidemiological data distinguishing the prognosis of these two related but distinct entities. PDS demonstrated significantly higher rates of recurrence and metastasis compared to AFX, supporting the clinical distinction between these tumors and informing follow-up protocols. The large sample size provides the most reliable outcome data to date for these uncommon tumors.

PDS carries significantly higher recurrence and metastasis risk than AFX, confirming they require different management approaches.

AFX has an excellent prognosis with very low recurrence rates when completely excised, while PDS warrants closer surveillance.

These population-level data support standardized follow-up protocols: more intensive monitoring for PDS than AFX.

This study analyzed survival outcomes and prognostic factors for dermatofibrosarcoma protuberans (DFSP) in a large cohort. The findings confirmed that DFSP has an excellent prognosis with appropriate surgical management, and identified tumor thickness and fibrosarcomatous transformation as key adverse prognostic factors.

DFSP has an excellent overall prognosis when treated with margin-controlled surgery such as Mohs, but fibrosarcomatous variants carry higher risk.

Tumor thickness and histologic subtype should guide the intensity of follow-up surveillance after DFSP treatment.

This SEER database analysis examined the epidemiology and outcomes of dermatofibrosarcoma protuberans (DFSP) in a large population-based cohort. The study characterized demographic patterns, treatment approaches, and survival outcomes, confirming the favorable prognosis of DFSP with appropriate surgical management.

DFSP has an excellent prognosis with low metastatic potential when treated with adequate surgical margins.

Mohs surgery is associated with the lowest recurrence rates for DFSP and should be considered the treatment of choice when feasible.

This study evaluated the subsequent skin cancer risk in patients diagnosed with atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS). Patients with AFX/PDS demonstrated an elevated risk of developing additional skin cancers, supporting the need for long-term dermatologic surveillance.

Patients with AFX or pleomorphic dermal sarcoma have an increased risk of developing subsequent skin cancers and require ongoing surveillance.

The elevated skin cancer risk in AFX/PDS patients likely reflects shared risk factors including UV exposure and immunosuppression.

This systematic review evaluated treatment approaches for desmoplastic trichoepithelioma, a benign but locally aggressive adnexal tumor that can mimic BCC. Mohs micrographic surgery was identified as the treatment of choice due to its ability to provide complete margin assessment and minimize recurrence.

Mohs surgery is the preferred treatment for desmoplastic trichoepithelioma due to superior margin control and low recurrence rates.

Accurate histologic differentiation of desmoplastic trichoepithelioma from morpheaform BCC is critical for appropriate treatment planning.

This study evaluated CK7 as an immunohistochemical marker for sebaceous carcinoma during Mohs micrographic surgery. CK7 demonstrated utility in identifying residual sebaceous carcinoma on frozen sections, improving the accuracy of margin assessment for this aggressive adnexal tumor.

CK7 immunostaining on frozen sections improves margin assessment accuracy during Mohs surgery for sebaceous carcinoma.

Incorporating CK7 into the Mohs histotechnique for sebaceous carcinoma can help ensure complete tumor clearance.

This review summarized the management of malignant adnexal tumors including microcystic adnexal carcinoma, sebaceous carcinoma, and other rare cutaneous appendageal neoplasms. The review highlighted the role of Mohs surgery, the importance of immunohistochemistry, and the need for multidisciplinary care.

Malignant adnexal tumors benefit from Mohs surgery due to their tendency for subclinical extension and perineural invasion.

Immunohistochemistry plays a critical role in the accurate diagnosis and margin assessment of adnexal carcinomas.

This outcomes analysis evaluated Mohs micrographic surgery for dermatofibrosarcoma protuberans (DFSP), assessing recurrence rates and margin clearance. The data confirmed excellent oncologic outcomes with Mohs for DFSP, with significantly lower recurrence compared to standard excision.

Mohs surgery is the treatment of choice for DFSP, with significantly lower recurrence rates than standard wide local excision.

Complete peripheral and deep margin assessment with Mohs is particularly important given DFSP's tendency for irregular subclinical extension.

This comprehensive atlas described the design and application of multi-lobed flaps for nasal reconstruction following Mohs surgery. The authors demonstrated how bilobed and trilobed flap variations can be tailored to different nasal subunits, providing reliable coverage with favorable cosmetic outcomes.

Multi-lobed flaps distribute wound closure tension across multiple areas, reducing distortion of critical nasal landmarks.

Understanding nasal subunit anatomy is essential for selecting the optimal lobed flap design for each defect location.

This study evaluated the risk of canalicular injury during periocular Mohs surgery and subsequent reconstruction. The authors identified anatomic zones of greatest risk and provided guidelines for intraoperative assessment and management of canalicular injuries to preserve lacrimal drainage function.

Canalicular injury risk is highest in Mohs defects involving the medial lower eyelid and medial canthal region.

Intraoperative probing and irrigation should be performed when canalicular injury is suspected, with prompt stenting if confirmed.

This comparative analysis investigated the relationship between suture material type and postoperative erythema in cutaneous surgery. The study found that suture composition influences the degree and duration of wound erythema, with implications for suture selection in cosmetically sensitive areas.

Suture material choice can affect the degree of postoperative erythema, particularly in cosmetically visible locations.

Monofilament and rapidly absorbing sutures may produce less inflammatory erythema compared to braided materials.

This study described the Twizzler technique for reconstructing scalp defects under high tension, particularly those with limited tissue laxity. The technique uses a rotational advancement approach that distributes tension effectively, enabling primary closure of defects that might otherwise require grafting.

The Twizzler technique provides an effective option for closing high-tension scalp defects that resist standard linear closure.

Understanding scalp tissue biomechanics and tension distribution is key to selecting appropriate reconstruction techniques for large scalp defects.

This study presented the long-necked reading man flap, a modified advancement flap designed for reconstructing distal dorsal finger defects. The technique provided reliable soft tissue coverage with preservation of nail bed and joint function, offering an alternative to skin grafting in this challenging anatomic location.

The long-necked reading man flap is a reliable option for distal dorsal finger reconstruction that preserves nail and joint function.

Local flap reconstruction of finger defects can provide superior functional and cosmetic outcomes compared to skin grafting.

This study evaluated complication rates and risk factors associated with interpolation flaps used in facial reconstruction after Mohs surgery. Overall complication rates were low, and the study identified factors such as smoking, anticoagulation, and flap location that influenced outcomes.

Interpolation flaps are generally safe for facial reconstruction with low complication rates when performed by experienced surgeons.

Modifiable risk factors such as smoking cessation and anticoagulation management should be addressed preoperatively to optimize interpolation flap outcomes.

This study reviewed processing methods for autologous adipose tissue used in fat grafting for reconstructive purposes after Mohs surgery. The review compared centrifugation, filtration, and washing techniques, providing guidance on optimizing graft viability for volume restoration and contour correction.

Autologous fat grafting is a viable option for volume restoration and contour correction after Mohs surgery.

Processing technique selection affects fat graft viability and long-term volume retention in reconstructive applications.

This study assessed the use of tranexamic acid for achieving hemostasis during eyelid and periocular surgical procedures. TXA demonstrated efficacy in reducing bleeding and improving the surgical field during delicate periocular reconstruction, with a favorable safety profile.

Tranexamic acid is effective for hemostasis in periocular surgery, improving visualization in this anatomically sensitive area.

The favorable safety profile of TXA supports its use as an adjunctive hemostatic measure during eyelid reconstruction.

This 12-year experience report evaluated the use of acellular dermal matrix (ADM) for nasal reconstruction after Mohs surgery. ADM demonstrated reliable wound healing and cosmetic outcomes, serving as an effective alternative to autologous grafts for complex nasal defects.

Acellular dermal matrix is a reliable option for nasal reconstruction after Mohs surgery, particularly for defects with exposed cartilage.

ADM provides a scaffold for tissue regeneration and eliminates donor site morbidity associated with autologous grafts.

This study compared full-thickness and split-thickness skin grafts for reconstruction of scalp defects with exposed calvarium. The analysis evaluated graft survival rates, healing times, and cosmetic outcomes to guide graft selection for this challenging reconstruction scenario.

Graft selection for scalp defects with exposed calvarium depends on the vascular bed quality and defect characteristics.

Both full-thickness and split-thickness skin grafts can achieve acceptable outcomes for scalp reconstruction when the recipient bed is properly prepared.

This study described the temporoparietal fasciocutaneous island flap for reconstruction of forehead and anterior scalp defects. The flap provides well-vascularized tissue coverage based on the superficial temporal artery, offering a reliable option for defects that cannot be closed with simpler techniques.

The temporoparietal fasciocutaneous island flap provides reliable, well-vascularized coverage for challenging forehead and anterior scalp defects.

Knowledge of superficial temporal artery anatomy is essential for successful planning and execution of this flap.

This study evaluated the safety and outcomes of accelerated takedown timing for melolabial interpolation flaps, comparing early versus traditional three-week takedown. Accelerated takedown demonstrated comparable complication rates and cosmetic results while reducing the period of patient inconvenience.

Accelerated takedown of melolabial interpolation flaps (as early as 1-2 weeks) is safe and produces comparable outcomes to traditional timing.

Earlier flap division reduces patient burden without compromising flap viability or cosmetic results.

This randomized controlled trial investigated whether early postoperative water exposure (showering/bathing) increases surgical site complications after dermatologic surgery. The study found no significant increase in infection or dehiscence rates with early water exposure, challenging traditional wound care restrictions.

Early postoperative water exposure does not significantly increase infection or complication rates after dermatologic surgery.

Traditional restrictions on bathing after skin surgery may be unnecessarily conservative and can be liberalized for patient convenience.

This study evaluated early takedown timing for postauricular, melolabial, and other interpolation flaps used in facial reconstruction. The data demonstrated that earlier flap division is safe and well-tolerated across multiple flap types, reducing the overall treatment duration without compromising outcomes.

Early takedown of interpolation flaps (postauricular, melolabial, and others) is safe and reduces patient inconvenience.

Accelerated flap division protocols can be adopted across various interpolation flap types without increasing complication rates.

This study described a single-stage transposition flap technique for auricular reconstruction after Mohs surgery. The approach eliminated the need for a second-stage procedure while providing reliable soft tissue coverage and good cosmetic outcomes for ear defects.

Single-stage transposition flaps offer an efficient one-visit reconstruction option for appropriate auricular defects after Mohs surgery.

Eliminating the need for a second-stage procedure improves patient convenience and reduces healthcare resource utilization.

This study reviewed eyelid reconstruction techniques after Mohs micrographic surgery, covering a range of approaches from direct closure to complex staged flaps. The review provided a systematic approach to reconstruction selection based on defect size, location, and depth within the eyelid.

Eyelid reconstruction after Mohs surgery should be guided by defect size, depth, and involvement of the lid margin or canthi.

A systematic approach to eyelid reconstruction ensures functional preservation of the eyelid and globe protection.

This study examined how postoperative defect size should guide reconstruction planning decisions after Mohs surgery. The analysis provided evidence-based criteria for selecting among closure methods (primary, flap, graft, second intention) based on final defect dimensions and anatomic location.

Postoperative defect size is a key determinant of reconstruction method selection and should be systematically assessed after Mohs surgery.

Evidence-based defect size thresholds can help standardize reconstruction decision-making and improve surgical outcomes.

This study investigated how the spacing of deep (buried) sutures affects wound closure outcomes including dehiscence, cosmetic appearance, and scar width. Results demonstrated that wider suture spacing did not significantly compromise wound outcomes compared to closely spaced sutures, suggesting that fewer deep sutures may be acceptable in many closures.

Wider deep suture spacing can achieve comparable wound outcomes to closely spaced sutures in appropriately selected closures.

Reducing the number of buried sutures may decrease operative time and foreign body burden without sacrificing cosmesis.

This study examined healing time and pain outcomes in auricular wounds managed by second intention healing after Mohs surgery. Results showed that second intention healing of the ear produces acceptable cosmetic outcomes with manageable pain, though healing times were longer than primary closure.

Second intention healing is a viable and often preferred option for auricular defects after Mohs surgery, particularly on the conchal bowl and antihelix.

Patients should be counseled that auricular second intention healing may take several weeks but typically yields good cosmetic results.

This study compared the shave-incision-healing (SIH) technique with standard second intention healing for auricular reconstruction after Mohs surgery. The SIH approach demonstrated comparable cosmetic outcomes while simplifying the repair process for appropriate ear defects.

The SIH technique offers a simple and effective alternative to traditional second intention healing for select auricular defects.

Auricular reconstruction strategy should be tailored to defect depth, location, and cartilage exposure.

This randomized controlled trial compared running subcuticular versus running horizontal mattress suture techniques for aesthetic outcomes in cutaneous surgery. The study assessed scar width, patient satisfaction, and cosmesis to guide suture technique selection for optimal wound closure.

Both running subcuticular and running horizontal mattress techniques can achieve excellent aesthetic outcomes in appropriate clinical scenarios.

Suture technique selection should consider anatomic location, wound tension, and skin thickness to optimize cosmetic results.

This randomized controlled trial evaluated whether adding 2-octyl cyanoacrylate (tissue adhesive) to intermediate layered closure improves aesthetic outcomes compared to intermediate closure alone. The study assessed the cosmetic and functional benefit of tissue adhesive as an adjunct to standard suture closure.

Adding tissue adhesive to standard layered closure may provide a modest cosmetic benefit and can serve as an alternative to superficial sutures.

2-Octyl cyanoacrylate offers the advantage of eliminating the need for suture removal when used as an epidermal closure substitute.

This study assessed the efficacy of compression therapy in promoting second intention wound healing after dermatologic surgery. The analysis evaluated healing rates, cosmetic outcomes, and patient comfort with compression dressing protocols for wounds managed by secondary intention.

Compression therapy can enhance second intention wound healing rates and may improve cosmetic outcomes for appropriate surgical defects.

Patient selection and wound location should guide the decision to incorporate compression therapy into second intention healing protocols.

This study compared hydrocolloid dressings with standard petrolatum-based wound care for post-surgical wound management. The comparison evaluated healing time, infection rates, patient convenience, and cosmetic outcomes between these two widely used wound care approaches.

Hydrocolloid dressings offer a convenient alternative to petrolatum-based wound care with comparable healing outcomes.

Patient preference and wound characteristics should guide dressing selection, as both hydrocolloid and petrolatum approaches produce acceptable results.

This study evaluated bleeding complications associated with novel oral anticoagulants (NOACs/DOACs) in dermatologic surgery. The analysis compared bleeding rates in patients on various NOACs versus those not on anticoagulation, providing evidence to guide perioperative anticoagulation management for dermatologic surgical procedures including Mohs surgery.

NOACs are associated with increased but generally manageable bleeding complications in dermatologic surgery.

Continuation of NOACs through dermatologic surgery is generally recommended to avoid thromboembolic risk from interruption.

Meticulous hemostasis techniques and pressure dressings are the primary management strategies for NOAC-related intraoperative bleeding.

This study evaluated preoperative oral tranexamic acid (TXA) administration for reducing bleeding complications in dermatologic surgery. The analysis demonstrated that preoperative TXA can decrease intraoperative blood loss and reduce the incidence of postoperative hematoma and ecchymosis, with a favorable safety profile in appropriately selected patients.

Preoperative oral TXA reduces intraoperative bleeding and postoperative hematoma rates in dermatologic surgery.

TXA is particularly beneficial for patients on antiplatelet or anticoagulant therapy undergoing surgical procedures.

Patient selection should exclude those with active thromboembolic disease or significant thrombotic risk factors.

This study assessed the impact of prophylactic antibiotic use on surgical site infection (SSI) rates in immunocompromised patients undergoing Mohs micrographic surgery. The findings helped clarify when antibiotic prophylaxis may be warranted in this higher-risk population and its effect on reducing postoperative infections.

Immunocompromised patients undergoing Mohs surgery have higher baseline SSI rates, and targeted antibiotic prophylaxis may be beneficial in select cases.

Routine antibiotic prophylaxis for all immunocompromised Mohs patients is not uniformly supported and should be guided by patient-specific risk factors.

This retrospective study characterized gram-negative surgical site infections following Mohs micrographic surgery. The analysis identified common gram-negative pathogens, predisposing risk factors, and clinical presentations. The findings have implications for empiric antibiotic selection when gram-negative SSI is suspected, as standard prophylactic regimens targeting gram-positive organisms may be insufficient for certain wound locations.

Gram-negative SSIs after Mohs surgery are uncommon but may be underrecognized, particularly for lower extremity and groin wounds.

Empiric antibiotic selection should consider gram-negative coverage for infections not responding to standard gram-positive therapy.

Culture-directed therapy is essential for SSIs that fail to improve with initial empiric antibiotic treatment.

This study evaluated the efficacy and safety of tranexamic acid (TXA) in reducing intraoperative bleeding during Mohs micrographic surgery. TXA administration was associated with reduced bleeding and improved visualization without significant adverse events, supporting its use as an adjunct hemostatic agent.

Tranexamic acid can effectively reduce intraoperative bleeding during Mohs surgery without significant safety concerns.

TXA may be particularly beneficial in patients on anticoagulation or in vascular anatomic sites prone to excessive bleeding.

This study evaluated the impact of chlorhexidine surgical skin preparation on infection rates in lower extremity Mohs surgery, a location known for higher SSI risk. The findings informed antiseptic selection for surgical prep in this challenging anatomic location.

Chlorhexidine skin preparation may reduce surgical site infection rates in lower extremity Mohs surgery.

Antiseptic prep selection for lower extremity surgery should consider the higher baseline infection risk of this anatomic location.

This study evaluated whether preoperative antibiotics reduce infection rates in lower extremity Mohs surgery. The results demonstrated that prophylactic antibiotics did not significantly change surgical site infection rates, suggesting that routine antibiotic prophylaxis is unnecessary for most lower extremity Mohs procedures.

Preoperative antibiotics do not significantly reduce surgical site infection rates in lower extremity Mohs surgery.

Routine antibiotic prophylaxis for lower extremity Mohs procedures is not supported by current evidence and should not be standard practice.

This study assessed bleeding complications following nerve block local anesthesia and local infiltration in patients receiving anticoagulation therapy during dermatologic surgery. The findings provided data on the safety of regional anesthesia techniques in anticoagulated patients and guided risk management strategies.

Nerve blocks and local infiltration in anticoagulated dermatologic surgery patients carry a manageable risk of bleeding complications.

Careful technique and awareness of vascular anatomy can minimize bleeding risk when performing nerve blocks in anticoagulated patients.

This study evaluated the risks of bacteremia, infective endocarditis, and prosthetic joint infection following dermatologic surgery. The analysis found extremely low rates of these complications, informing evidence-based guidelines on antibiotic prophylaxis for patients with cardiac or orthopedic implants.

The risk of bacteremia, endocarditis, and prosthetic joint infection after dermatologic surgery is extremely low.

Routine antibiotic prophylaxis for cardiac valvular disease or prosthetic joints is not warranted for most dermatologic procedures.

This study evaluated the impact of 2-octyl cyanoacrylate (tissue adhesive) on surgical site infection rates following lower extremity dermatologic surgery. The analysis assessed whether tissue adhesive application provides a protective barrier against wound contamination in this high-infection-risk anatomic location.

Tissue adhesive application may help reduce surgical site infection risk in lower extremity surgery by providing a protective wound barrier.

2-Octyl cyanoacrylate offers potential dual benefits of wound closure and infection prevention in lower extremity dermatologic procedures.

This study demonstrated that bupivacaine local anesthesia, compared to lidocaine alone, significantly reduces post-operative narcotic analgesic use in dermatologic surgery patients. The longer duration of action of bupivacaine provides extended post-operative pain control, resulting in decreased opioid consumption and improved patient comfort during the immediate post-operative period.

Bupivacaine provides significantly longer post-operative analgesia compared to lidocaine in dermatologic surgery.

Use of bupivacaine reduces post-operative narcotic analgesic use, supporting opioid-sparing pain management strategies.

Combining bupivacaine with lidocaine offers both rapid onset and prolonged duration of anesthesia.

This multicenter prospective study evaluated pain levels associated with lidocaine injection during subsequent stages of Mohs surgery. Results showed that patients experience progressively less pain with each subsequent injection, likely due to residual anesthesia and tissue changes from prior stages.

Patients should be reassured that lidocaine injections during later Mohs stages are typically less painful than the initial injection.

Residual local anesthesia from prior stages reduces the discomfort of re-injection during multi-stage Mohs procedures.

This study analyzed patterns of opioid prescribing following facial plastic and reconstructive procedures. The findings revealed frequent over-prescribing relative to patient needs, with many patients using significantly fewer opioids than prescribed, supporting efforts to limit postoperative opioid prescriptions.

Opioid prescriptions after facial procedures frequently exceed patient consumption, contributing to excess opioid availability.

Mohs and reconstructive surgeons should adopt evidence-based opioid prescribing guidelines to reduce unnecessary prescriptions.

This study reviewed lidocaine dosing guidelines and safety considerations in dermatologic surgery, addressing maximum doses, toxicity risk factors, and clinical monitoring. The findings provided updated recommendations for safe lidocaine administration in both standard and extended dermatologic procedures.

Current evidence supports higher safe lidocaine doses than traditionally cited, particularly when used with epinephrine in dermatologic surgery.

Patient weight, hepatic function, and concurrent medications should be considered when calculating safe lidocaine doses.

This study examined how anatomic location influences anesthesia duration and the need for re-injection during Mohs micrographic surgery. Significant variation in anesthesia duration was found across body sites, with implications for operative planning and patient comfort management.

Anesthesia duration during Mohs surgery varies significantly by anatomic location, with some sites requiring more frequent re-injection.

Understanding site-specific anesthesia duration helps with surgical scheduling and proactive patient comfort management.

This study analyzed trends in opioid prescribing among Mohs surgeons from 2014 through 2022. The data showed a significant decline in opioid prescriptions over the study period, reflecting successful adoption of opioid-sparing postoperative pain management strategies within the Mohs surgery community.

Opioid prescribing by Mohs surgeons has decreased significantly since 2014, reflecting broader efforts to reduce unnecessary opioid use.

Non-opioid pain management strategies are effective for most Mohs surgery patients and should be the default postoperative approach.

This feasibility study evaluated the use of digital pathology with whole-slide imaging (WSI) in Mohs micrographic surgery workflow. The study assessed diagnostic accuracy, workflow integration, and turnaround time when using WSI for frozen section interpretation during Mohs cases. Results demonstrated high diagnostic accuracy comparable to conventional microscopy, with potential workflow advantages including remote consultation capability and digital archiving. The study represents an important step toward digital transformation of Mohs surgery pathology.

Whole-slide imaging demonstrates diagnostic accuracy comparable to conventional microscopy for Mohs frozen section interpretation.

Digital pathology enables remote consultation and quality assurance capabilities not possible with traditional microscopy.

Implementation challenges include scanning speed for intraoperative use and the need for validated digital pathology platforms.

This systematic review and meta-analysis comprehensively evaluated all published studies on artificial intelligence (AI) applications in Mohs micrographic surgery and dermatologic surgery. The analysis assessed AI performance in tumor detection, margin assessment, and surgical planning assistance. Results showed promising accuracy metrics for AI-assisted pathology interpretation, though most studies were limited by small sample sizes and single-center designs. The review identifies current capabilities and gaps in AI integration into dermatologic surgery workflows.

AI demonstrates high accuracy for BCC and SCC detection on frozen sections, but most studies are single-center with limited external validation.

Current AI tools show greatest promise as decision-support aids rather than autonomous diagnostic systems in Mohs surgery.

Integration of AI into Mohs workflow requires addressing scanning speed, regulatory approval, and prospective validation challenges.

This systematic review evaluated artificial intelligence applications in Mohs micrographic surgery, including automated tissue processing, margin assessment, and tumor detection on histologic slides. The review summarized current evidence for AI integration and identified barriers to clinical implementation.

AI shows promising potential for assisting Mohs surgeons in tumor detection and margin assessment on frozen sections.

Clinical implementation of AI in Mohs surgery requires further validation studies and integration with existing histotechnique workflows.

This study evaluated the use of AI-assisted tools for billing and coding in dermatologic surgery practices. The findings assessed accuracy, efficiency gains, and potential revenue impact of AI-based coding assistance compared to traditional manual coding methods.

AI-assisted billing and coding tools can improve coding accuracy and efficiency in dermatologic surgery practices.

Adoption of AI coding tools may reduce billing errors and optimize reimbursement while decreasing administrative burden.

This evidence review summarized the current data on radiation therapy for keloid treatment and prevention, including protocols for dosing and fractionation. The review supported adjuvant radiation as one of the most effective therapies for recalcitrant keloids, particularly when combined with surgical excision.

Adjuvant radiation therapy within 24-48 hours of keloid excision significantly reduces recurrence rates.

Radiation protocols for keloids typically use superficial radiation with relatively low total doses, offering a favorable risk-benefit profile.

This 22-year retrospective study evaluated superficial X-ray radiation therapy (SRT) for the treatment of non-aggressive BCC and SCC in elderly patients. The long-term data demonstrated high cure rates and low recurrence, supporting SRT as a viable non-surgical alternative for older patients unable or unwilling to undergo surgery.

Superficial X-ray radiation therapy achieves high cure rates for non-aggressive NMSC in elderly patients over long-term follow-up.

SRT is a well-tolerated non-surgical option for elderly patients with BCC or SCC who are poor surgical candidates.

This Medicare trend analysis examined the volume and distribution of radiotherapy performed by dermatologists from 2016 to 2021. The data revealed significant growth in dermatologist-administered radiation therapy, raising questions about appropriate utilization and the role of dermatologists in radiation-based skin cancer treatment.

Dermatologist-administered radiation therapy for skin cancer has increased substantially in recent years.

The growth in office-based radiation by dermatologists warrants scrutiny regarding appropriate patient selection and quality assurance.

This study demonstrated that adjuvant radiation therapy reduces both local recurrence and nodal metastasis rates in high-risk localized cutaneous SCC. The data supported the role of postoperative radiation in improving locoregional control for tumors with high-risk features.

Adjuvant radiation significantly reduces local recurrence and nodal metastasis in high-risk localized cSCC.

Postoperative radiation should be strongly considered for cSCC with perineural invasion, deep invasion, or positive margins.

This comprehensive review evaluated nonexcisional treatment modalities for superficially invasive and in situ squamous cell carcinoma, including topical therapies (5-fluorouracil, imiquimod), photodynamic therapy, radiation therapy, and other alternatives to surgical excision. The analysis compared cure rates, recurrence, and cosmetic outcomes across treatment modalities, providing guidance for cases where surgery may not be the optimal approach.

Topical 5-FU and imiquimod show reasonable efficacy for SCC in situ but with higher recurrence rates than surgical excision.

Photodynamic therapy offers good cosmetic outcomes for superficial SCC but with limited depth of treatment penetration.

Nonexcisional approaches are best reserved for patients who are poor surgical candidates or have low-risk, superficial disease.

This study analyzed FDA MAUDE database reports to evaluate the efficacy and safety profile of noninvasive fat and cellulite reduction devices. The analysis revealed significant variability in reported outcomes and identified concerning adverse event patterns, highlighting the need for evidence-based device selection.

FDA MAUDE data suggest variable efficacy and notable adverse events among noninvasive body contouring devices.

Clinicians should critically evaluate marketing claims for fat and cellulite reduction devices against available clinical evidence and safety data.

This study evaluated early application of fractional CO2 laser therapy to surgical scars to improve cosmetic outcomes. Early treatment (within weeks of surgery) was associated with improved scar appearance compared to delayed intervention or no treatment, supporting integration of laser therapy into postoperative scar management.

Early fractional CO2 laser treatment of surgical scars can improve cosmetic outcomes compared to delayed treatment.

Incorporating laser scar therapy into routine post-surgical follow-up protocols may enhance patient satisfaction with wound healing.

This meta-analysis assessed the efficacy of photodynamic rejuvenation (PDR) for treating actinic keratoses. Pooled data demonstrated that PDR effectively reduces AK counts while providing additional cosmetic benefits including improved skin texture and pigmentation, supporting its dual therapeutic and aesthetic role.

Photodynamic therapy effectively treats actinic keratoses while simultaneously improving overall skin photodamage.

PDR can serve as both a therapeutic intervention for AK and an aesthetic treatment for photodamaged skin.

This multicenter randomized controlled trial compared surgical excision with a combination of topical 5-fluorouracil and photodynamic therapy for the treatment of Bowen's disease (SCC in situ). The results informed treatment selection by comparing recurrence rates, cosmetic outcomes, and patient preferences between surgical and non-surgical approaches.

Both surgical excision and 5-FU/PDT combination therapy are viable treatment options for Bowen's disease with acceptable outcomes.

Non-surgical approaches for Bowen's disease may be preferred in locations where surgery would result in significant functional or cosmetic compromise.

This study evaluated a deep shave removal technique with curettage for the treatment of basal cell carcinoma. The approach demonstrated acceptable cure rates for select low-risk BCCs while offering a simpler and faster alternative to standard excision or Mohs surgery.

Deep shave removal with curettage can be an effective treatment for carefully selected low-risk BCCs.

This technique should be reserved for appropriate clinical scenarios and is not a substitute for Mohs surgery in high-risk BCC.

This study evaluated outcomes of electrodesiccation and curettage (ED&C) for squamous cell carcinoma in situ (SCCis). Results demonstrated reasonable cure rates for ED&C in treating SCCis, though recurrence rates varied by anatomic location and lesion size.

ED&C can be an effective treatment option for SCCis in carefully selected cases, particularly smaller lesions on the trunk and extremities.

Recurrence rates after ED&C for SCCis are higher than surgical excision, warranting close follow-up.

This JAAD study evaluated the efficacy of topical 5-fluorouracil (5-FU) for the treatment of squamous cell carcinoma in situ. The data demonstrated that 5-FU can achieve meaningful clinical and histologic clearance of SCCis, supporting its role as a non-surgical treatment option for select patients.

Topical 5-FU is an effective non-surgical treatment option for SCC in situ in appropriately selected patients.

Non-surgical management of SCCis with 5-FU may be preferred in patients who are poor surgical candidates or have multiple lesions.

This study compared imiquimod cream preceded by superficial curettage with surgical excision for the treatment of nodular basal cell carcinoma. The comparison evaluated cure rates, cosmetic outcomes, and patient preferences to guide treatment selection for this common BCC subtype.

Curettage followed by imiquimod may be a viable non-surgical alternative for select nodular BCCs, though surgical excision remains the gold standard.

Patient preference and tumor characteristics should guide the choice between surgical and non-surgical approaches for nodular BCC.

This multi-factor analysis identified key risk factors for surgical site infection (SSI) in dermatologic surgery procedures. The study analyzed patient, procedural, and wound-related variables that predict SSI development, providing evidence-based guidance for infection prevention strategies. The findings have practical implications for perioperative antibiotic use and wound management protocols in dermatologic surgery.

Key SSI risk factors in dermatologic surgery include lower extremity location, flap/graft closures, and patient immunosuppression.

Prophylactic antibiotics should be targeted based on identified risk factors rather than administered universally.

Wound location below the knee and complex reconstructions are among the strongest predictors of SSI.

This study evaluated the incidence and risk factors for temporal (facial) nerve branch injury during Mohs surgery. The authors identified high-risk anatomic zones and provided strategies for minimizing iatrogenic nerve damage during tumor extirpation and reconstruction.

The temporal branch of the facial nerve is most vulnerable in the temple and lateral forehead regions during Mohs surgery.

Knowledge of the temporal nerve course relative to surgical landmarks is essential for preventing motor nerve injury during Mohs procedures.

This review provided updated evidence on actinic keratosis field therapy approaches including topical fluorouracil, imiquimod, ingenol mebutate, photodynamic therapy, and combination strategies. The review synthesized recent trial data to guide clinicians in selecting the most effective field therapy for individual patient profiles.

AK field therapy reduces the overall burden of actinic damage and may decrease the risk of progression to invasive SCC.

Selection of field therapy should be individualized based on AK burden, location, patient tolerance, and prior treatment response.

This study investigated whether pulsed dye laser (PDL) treatment can reduce the risk of developing keratinocyte carcinomas (BCC and SCC). The analysis evaluated the chemopreventive potential of PDL through its effects on photodamaged skin vasculature and precancerous lesions.

Pulsed dye laser treatment shows potential as a chemopreventive strategy for keratinocyte cancers by targeting photodamaged skin.

Further controlled studies are needed to establish the long-term efficacy of PDL for skin cancer prevention.

This study evaluated the chemoprophylactic effect of PD-1/PD-L1 immune checkpoint inhibitors on the development of new keratinocyte cancers (BCC and SCC) in patients receiving immunotherapy for other malignancies. The findings suggested a potential protective effect against new keratinocyte cancer formation during checkpoint inhibitor treatment.

PD-1/PD-L1 checkpoint inhibitors may have a chemopreventive effect on keratinocyte cancer development in treated patients.

This immune surveillance enhancement could represent a secondary benefit of checkpoint inhibitor therapy in patients at high risk for skin cancer.

This 2025 update reviewed the evidence for nicotinamide (vitamin B3) as a chemopreventive agent for skin cancer, including updated trial data and clinical recommendations. The review confirmed that nicotinamide reduces the rate of new NMSC and actinic keratoses in high-risk patients with a favorable safety profile.

Nicotinamide 500 mg twice daily reduces new NMSC and AK rates in high-risk patients and remains a well-tolerated chemopreventive option.

The chemopreventive benefit of nicotinamide requires continuous use, as the effect diminishes after discontinuation.

This study examined the role of immune checkpoint inhibitors in managing field cancerization and preventing new keratinocyte cancer development. The review synthesized emerging evidence on how systemic immunotherapy influences the broader field of sun-damaged skin beyond individual tumor treatment.

Immune checkpoint inhibitors may address field cancerization by enhancing immune surveillance across sun-damaged skin.

The intersection of immunotherapy and chemoprevention is an active area of investigation for high-risk patients.

This study examined whether immune status independently predicts metastasis in cutaneous squamous cell carcinoma (cSCC) after controlling for tumor stage. Results showed that when patients were stratified by BWH or AJCC tumor stage, immunosuppression did not independently increase the risk of metastasis, suggesting that tumor stage is the dominant prognostic factor.

Tumor stage remains the primary driver of metastatic risk in cSCC, even in immunosuppressed patients.

Staging systems should be applied uniformly regardless of immune status when assessing metastatic potential of cSCC.

This feasibility study evaluated topical treatment of actinic keratoses (AKs) in organ transplant recipients, a population with a high burden of AKs and elevated risk of progression to SCC. The study demonstrated that topical field therapy is feasible and tolerable in transplant recipients, supporting its role in skin cancer prevention.

Topical field therapy for AKs is feasible and well-tolerated in organ transplant recipients despite their immunosuppressed state.

Regular AK field treatment in transplant recipients may help reduce the high rate of progression to invasive SCC in this population.

This study compared high-risk prognostic tumor features of cutaneous SCC in organ transplant recipients (OTRs) versus the general population. OTRs demonstrated a higher prevalence of adverse histologic features including perineural invasion and poor differentiation, supporting the need for more aggressive surveillance and treatment strategies.

SCC in organ transplant recipients more frequently exhibits high-risk histologic features compared to immunocompetent patients.

Transplant recipients with SCC may benefit from closer surveillance and a lower threshold for adjuvant treatment due to their higher-risk tumor biology.

This JAMA Dermatology study quantified the rates of second primary tumors, metastasis, and death in transplant recipients with cutaneous SCC. The data revealed substantially higher rates of all adverse outcomes compared to the general population, reinforcing the aggressive nature of cSCC in immunosuppressed patients.

Transplant recipients with cSCC face significantly elevated risks of second tumors, metastasis, and disease-specific mortality.

Multidisciplinary management and enhanced surveillance protocols are critical for transplant recipients diagnosed with cSCC.

This international SCOPE-IT study evaluated metastasis risk factors for SCC in organ transplant recipients across multiple centers. The study identified key clinical and histopathologic predictors of metastasis that can help guide management intensity in this high-risk population.

Large tumor diameter and deep invasion are strong predictors of SCC metastasis in organ transplant recipients.

International collaborative data from SCOPE-IT provides robust evidence to guide risk-adapted management of SCC in transplant patients.

This study described the implementation and outcomes of a structured skin cancer surveillance program for solid organ transplant recipients. The program demonstrated improved early detection of skin cancers and better adherence to dermatologic follow-up in this high-risk population.

Structured skin cancer surveillance programs for transplant recipients improve early detection and treatment outcomes.

All solid organ transplant recipients should be enrolled in regular dermatologic screening given their markedly elevated skin cancer risk.

This study examined patient education practices regarding scarring expectations after Mohs surgery. The findings highlighted gaps in preoperative counseling about scar outcomes and identified opportunities to improve patient understanding and satisfaction through enhanced educational materials.

Preoperative counseling about expected scarring improves patient satisfaction and reduces unrealistic expectations after Mohs surgery.

Standardized patient education tools for scar outcomes can help bridge communication gaps in Mohs surgery practices.

This study evaluated fellow productivity in outpatient procedural settings (OPS) within Mohs surgery practices. Fellow involvement was associated with practice efficiency gains, and the study characterized the volume and complexity of cases managed during fellowship training.

Mohs surgery fellows contribute meaningfully to practice productivity while developing procedural competency.

Structured fellowship training in Mohs surgery provides adequate case volume for skill development in both extirpation and reconstruction.

This study identified predictors of low health literacy among Mohs surgery patients and assessed the impact on understanding of their diagnosis and treatment. The findings highlighted the need for tailored educational materials and communication strategies for patients with limited health literacy.

Low health literacy is common among Mohs patients and is associated with poorer understanding of skin cancer diagnosis and treatment.

Written educational materials for Mohs patients should be designed at an appropriate reading level and supplemented with visual aids.

This market analysis examined Mohs surgeons' dominance in the skin cancer surgery market, evaluating trends in procedure volume, market share, and practice patterns. The data confirmed that Mohs surgeons perform the majority of skin cancer surgeries and that this market share continues to grow.

Mohs surgeons continue to expand their market share in skin cancer surgery due to superior cure rates and tissue conservation.

The growing dominance of Mohs surgery reflects broader trends toward evidence-based, cost-effective skin cancer treatment.

This study evaluated the availability and quality of patient education tools used in Mohs dermatologic surgery practices. The assessment identified gaps in existing educational materials and provided recommendations for developing more effective patient-facing resources.

Current patient education tools for Mohs surgery vary widely in quality and may not address common patient concerns adequately.

Developing standardized, evidence-based patient education materials can improve preoperative understanding and reduce anxiety.

This training analysis investigated the number of initial biopsies required for trainees to achieve competency in Mohs micrographic surgery. The study established minimum case thresholds for developing proficiency in histologic interpretation and surgical decision-making during Mohs fellowship.

A minimum number of interpreted Mohs slides is needed to achieve competency, supporting structured training volume requirements.

Tracking trainee performance metrics during Mohs fellowship helps ensure adequate skill development before independent practice.

This ACMS survey reviewed the intraoperative anxiolytic practices employed by Mohs surgeons to manage patient anxiety during surgery. The survey revealed wide variation in approaches, including oral benzodiazepines, distraction techniques, and non-pharmacologic methods, with no consensus standard of care.

Mohs surgeons use a wide range of anxiolytic strategies, and individualized patient-centered approaches are recommended.

Non-pharmacologic interventions such as music, communication, and distraction can effectively reduce patient anxiety during Mohs surgery.

This randomized controlled trial evaluated the efficacy and safety of anxiolytics administered during Mohs micrographic surgery. The study assessed the impact of pharmacologic anxiolysis on patient anxiety levels, satisfaction, and procedural outcomes during Mohs surgery, where patients often experience significant wait-time anxiety between stages.

Anxiolytic administration during Mohs surgery can significantly reduce patient-reported anxiety without compromising safety.

Wait-time anxiety between Mohs stages is a major source of patient distress that can be pharmacologically addressed.

Careful patient selection and monitoring are essential when administering anxiolytics in the outpatient surgical setting.

This study evaluated topical and systemic tranexamic acid (TXA) for managing hemorrhagic complications in surgical patients, including dermatologic surgery applications. The analysis assessed TXA efficacy in reducing intraoperative bleeding and postoperative hematoma formation, as well as the safety profile of IV TXA in surgical patients.

Topical TXA can reduce intraoperative bleeding in dermatologic surgery without significant systemic effects.

IV TXA carries a small but real risk of thromboembolic events and should be used judiciously in surgical patients.

TXA is particularly useful for patients on anticoagulation therapy undergoing dermatologic surgery to manage bleeding risk.

This study evaluated the CAPABLE program for enhancing patient experience in Mohs dermatologic surgery through standardized communication and care protocols. The program demonstrated improvements in patient satisfaction scores and reduced anxiety through structured pre-, intra-, and post-operative patient engagement.

Structured patient experience programs like CAPABLE can significantly improve satisfaction and reduce anxiety in Mohs surgery patients.

Standardized communication protocols throughout the surgical journey enhance patient-centered care in dermatologic surgery.

This prospective cohort study identified predictors of patient satisfaction with Mohs surgery at the time of surgery and at 3-month follow-up. Key factors influencing satisfaction included scar cosmesis, perceived communication quality, and defect size, providing targets for practice improvement.

Patient satisfaction with Mohs surgery is strongly influenced by scar cosmesis and the quality of surgeon-patient communication.

Assessing satisfaction at both immediate and 3-month timepoints captures different aspects of the patient experience.

This study investigated the association between tumor size and upstaged cSCC in patients with skin of color. The findings highlighted that certain clinical features may predict upstaging in diverse patient populations and emphasized the importance of equitable skin cancer care.

Tumor size is significantly associated with cSCC upstaging in patients with skin of color.

Skin cancer surveillance and education should be tailored to address the unique presentation and risk factors in patients with darker skin types.

This study evaluated strategies for improving follow-up care after skin cancer treatment based on Choosing Wisely principles. The findings identified barriers to appropriate follow-up and provided frameworks for optimizing surveillance schedules and patient engagement.

Evidence-based follow-up protocols after skin cancer treatment should balance oncologic surveillance with avoiding unnecessary healthcare utilization.

Patient education about the importance and appropriate frequency of follow-up visits improves adherence to post-treatment surveillance.

This malpractice analysis reviewed lawsuits filed against dermatologists, identifying common allegations, outcomes, and risk factors for litigation. The findings highlighted areas of practice most vulnerable to legal action and provided strategies for risk mitigation.

Procedural complications, diagnostic errors, and scarring are the most common allegations in malpractice lawsuits against dermatologists.

Thorough documentation, informed consent, and clear patient communication are key strategies for reducing malpractice risk in dermatologic surgery.

This study compared phenol-based matrixectomy with chemical matrixectomy techniques for nail ablation. The comparison evaluated cure rates, pain levels, healing time, and complications between the two approaches, providing guidance for procedure selection in nail surgery.

Both phenol and chemical matrixectomy are effective for nail ablation, with differences primarily in healing time and postoperative pain.

Procedure selection for matrixectomy should consider patient factors, nail pathology, and provider experience with each technique.