Camayo Tatiana V., Dane Alexander
Kansas City University GME Consortium
Mohs micrographic surgery (MMS) is a surgical technique commonly used to treat cutaneous malignancies such as squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). MMS is performed in several stages, progressively removing malignant tissue while preserving healthy tissue and achieving high cure rates. The main advantage of MMS is the ability to assess all margins through the removal of tumor layers, which are processed in frozen sections. This histological assessment of the entire margin is crucial to determine tumor clearance before defect reconstruction, usually occurring in a single surgical session. MMS is currently the mainstay treatment for non-melanoma skin cancer, including SCC and BCC. MMS has shown benefits in treating these cancers, significantly reducing recurrence rates in both tumors. Uncommon cutaneous malignancies (UCMs) are skin tumors that, although infrequent, are usually associated with poor outcomes and worse prognosis compared to their more common counterparts. MMS has proven useful in treating UCMs, such as dermatofibrosarcoma protuberans. Recently, several studies have highlighted different UCMs treated with MMS, including angiosarcoma, eccrine malignant tumors, Paget disease, and Merkel cell carcinoma (MCC). Due to their high metastatic potential, MMS's role in treating UCMs has been questioned, especially in angiosarcoma and MCC. Usually, UCMs benefit from treatment with wide local excisions (WLEs). However, MMS has been used alternative option for UCMs over the past decade, supported by several case reports and series demonstrating its beneficial effects on UCM management. In recent years, study groups worldwide have assessed the efficacy, impact on prognosis, and relevance of MMS beyond its common indications. Nonetheless, the value of MMS for some UCMs remains to be fully defined. The following discussion reviews the available evidence on the role of MMS in treating specific UCMs.
莫氏显微外科手术（MMS）是一种常用于治疗皮肤恶性肿瘤的外科技术，如鳞状细胞癌（SCC）和基底细胞癌（BCC）。MMS分几个阶段进行，逐步切除恶性组织，同时保留健康组织并实现高治愈率。MMS的主要优点是能够通过切除肿瘤层来评估所有切缘，这些肿瘤层在冰冻切片中进行处理。对整个切缘进行这种组织学评估对于在缺损重建之前确定肿瘤清除情况至关重要，缺损重建通常在一次手术中进行。MMS目前是非黑色素瘤皮肤癌（包括SCC和BCC）的主要治疗方法。MMS在治疗这些癌症方面已显示出益处，显著降低了两种肿瘤的复发率。罕见皮肤恶性肿瘤（UCMs）是皮肤肿瘤，虽然不常见，但与更常见的同类肿瘤相比，通常预后较差。MMS已被证明对治疗UCMs有用，如隆突性皮肤纤维肉瘤。最近，几项研究强调了用MMS治疗的不同UCMs，包括血管肉瘤、汗腺恶性肿瘤、佩吉特病和默克尔细胞癌（MCC）。由于其高转移潜能，MMS在治疗UCMs中的作用受到质疑，尤其是在血管肉瘤和MCC中。通常，UCMs受益于广泛局部切除（WLEs）治疗。然而，在过去十年中，MMS已被用作UCMs的替代选择，有几份病例报告和系列研究证明了其对UCMs管理的有益效果。近年来，世界各地的研究小组评估了MMS超出其常见适应证的疗效、对预后的影响及相关性。尽管如此，MMS对某些UCMs的价值仍有待充分明确。以下讨论回顾了关于MMS在治疗特定UCMs中作用的现有证据。
