Tolkachjov Stanislav N, Brodland David G, Coldiron Brett M, Fazio Michael J, Hruza George J, Roenigk Randall K, Rogers Howard W, Zitelli John A, Winchester Daniel S, Harmon Christopher B
Surgical Dermatology Group, Birmingham, AL.
Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA; Zitelli & Brodland, P.C., Pittsburgh, PA.
Mayo Clin Proc. 2017 Aug;92(8):1261-1271. doi: 10.1016/j.mayocp.2017.04.009.
The incidence and diagnosis of cutaneous malignancies are steadily rising. In addition, with the aging population and increasing use of organ transplant and immunosuppressive medications, subsets of patients are now more susceptible to skin cancer. Mohs micrographic surgery (MMS) has become the standard of care for the treatment of high-risk nonmelanoma skin cancers and is increasingly used to treat melanoma. Mohs micrographic surgery has the highest cure rates, spares the maximal amount of normal tissue, and is cost-effective for the treatment of cutaneous malignancies. As in other medical fields, appropriate use criteria were developed for MMS and have become an evolving guideline for determining which patients and tumors are appropriate for referral to MMS. Patients with cutaneous malignancies often require multidisciplinary care. With the changing landscape of medicine and the rapidly increasing incidence of skin cancer, primary care providers and specialists who do not commonly manage cutaneous malignancies will need to have an understanding of MMS and its role in patient care. This review better familiarizes the medical community with the practice of MMS, its utilization and capabilities, differences from wide excision and vertical section pathology, and cost-effectiveness, and it guides practitioners in the process of appropriately evaluating and determining when patients with skin cancer might be appropriate candidates for MMS.
皮肤恶性肿瘤的发病率和诊断率正在稳步上升。此外，随着人口老龄化以及器官移植和免疫抑制药物使用的增加，现在有部分患者更容易患皮肤癌。莫氏显微外科手术（MMS）已成为治疗高危非黑色素瘤皮肤癌的标准治疗方法，并且越来越多地用于治疗黑色素瘤。莫氏显微外科手术具有最高的治愈率，能最大程度地保留正常组织，且在治疗皮肤恶性肿瘤方面具有成本效益。与其他医学领域一样，已制定了MMS的合理使用标准，并且该标准已成为确定哪些患者和肿瘤适合转诊至MMS的不断发展的指南。皮肤恶性肿瘤患者通常需要多学科护理。随着医学形势的变化以及皮肤癌发病率的迅速上升，不常处理皮肤恶性肿瘤的初级保健提供者和专科医生将需要了解MMS及其在患者护理中的作用。本综述使医学界更熟悉MMS的实践、其应用和能力、与广泛切除及垂直切片病理学的差异以及成本效益，并指导从业者在适当评估和确定皮肤癌患者何时可能适合MMS治疗的过程中发挥作用。
