Maciejewska Magdalena, Bętkowska Aleksandra, Czuwara Joanna, Rudnicka Lidia, Banciu Laura, Tebeica Tiberiu, Leventer Mihaela
Department of Dermatology, Medical University of Warsaw, Nowogrodzka 59, 02-014, Warsaw, Poland.
Dr Leventer Centre, Bucharest, Romania.
Adv Ther. 2025 Sep 18. doi: 10.1007/s12325-025-03354-w.
Mohs micrographic surgery (MMS) is a method used to treat skin cancers. It ensures a complete microscopic examination of the tumor margins with the conservation of surrounding tissue, leading to high cure rates and favorable cosmetic outcomes. In each Mohs stage, the excised specimen is frozen and sectioned horizontally, and its margins are evaluated for the presence of malignant cells. A variety of staining methods can be employed, including immunohistochemical. The process is repeated until all margins are negative. The most common indications for MMS are non-melanoma skin cancers, but it is increasingly utilized for other skin lesions, such as melanoma, lentigo maligna, and dermatofibrosarcoma protuberans. A growing body of evidence indicates significantly higher cure rates and a lower risk of local recurrence associated with MMS compared to other surgical modalities. Numerous modifications of the Mohs surgical technique have been developed to enhance the accuracy of margin control and to tackle specific challenges associated with various tumor types. Such alternative approaches include the "spaghetti technique," the "slow Mohs" technique, and other variations such as the Munich method, the square method, the muffin technique, or the perimeter technique. Complications are rare and include infections, bleeding, or impaired wound healing. The increasing popularity of noninvasive imaging, digital pathology, and artificial intelligence models will likely enhance the efficiency of MMS in the future. Machine learning can predict diagnoses, recommend treatment options, predict responses to treatment and potential drug interactions, or help plan surgical procedures, enabling dermatologists to tailor therapies to individual patient characteristics. In addition to presenting the latest trends in Mohs micrographic surgery, this article includes a selection of clinical cases, with an overview of the treatment protocols followed by our institution, as well as data on recurrences based on our clinical experience.
莫氏显微外科手术（MMS）是一种用于治疗皮肤癌的方法。它能确保在保留周围组织的情况下对肿瘤边缘进行完整的显微镜检查，从而实现高治愈率和良好的美容效果。在每个莫氏手术阶段，切除的标本被冷冻并水平切片，然后评估其边缘是否存在恶性细胞。可以采用多种染色方法，包括免疫组织化学方法。该过程反复进行，直到所有边缘均为阴性。MMS最常见的适应证是非黑色素瘤皮肤癌，但它越来越多地用于其他皮肤病变，如黑色素瘤、恶性雀斑样痣和隆突性皮肤纤维肉瘤。越来越多的证据表明，与其他手术方式相比，MMS的治愈率显著更高，局部复发风险更低。为了提高边缘控制的准确性并应对与各种肿瘤类型相关的特定挑战，人们开发了许多莫氏手术技术的改良方法。这些替代方法包括“意大利面条技术”、“慢速莫氏”技术以及其他变体，如慕尼黑方法、方形方法、松饼技术或周边技术。并发症很少见，包括感染、出血或伤口愈合受损。无创成像、数字病理学和人工智能模型的日益普及可能会在未来提高MMS的效率。机器学习可以预测诊断、推荐治疗方案、预测对治疗的反应和潜在的药物相互作用，或帮助规划手术程序，使皮肤科医生能够根据个体患者特征量身定制治疗方案。除了介绍莫氏显微外科手术的最新趋势外，本文还包括一系列临床病例，概述了我们机构遵循的治疗方案，以及基于我们临床经验的复发数据。
