Mohs Micrographic Surgery for Melanoma Leads to Excessive Tissue Excision

This case study examines a situation where an adult female patient underwent Mohs micrographic surgery for melanoma in situ, resulting in allegations of excessive tissue excision and significant disfigurement.

ByExpert Institute

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Published on February 6, 2024

Dermatologist Inspecting Woman's Cheek

Case Overview

This case study focuses on a female adult with melanoma in situ on her cheek. Using a punch biopsy, the 3 mm lesion was excised and she underwent Mohs micrographic surgery in February for further excision. There were allegations that the first and only excision stage was excessively large (25 mm diameter circle), resulting in disfigurement.

Consequently, the patient required extensive plastic surgery and skin grafts. Mohs procedure standards of care are challenged in this case.

Questions to the expert and their responses

Q1

How often do you perform Mohs micrographic surgery on patients diagnosed with melanoma?

As a board-certified dermatologist specializing in micrographic dermatologic surgery, I perform Mohs Surgery on melanoma patients several times weekly, sometimes even daily.

Q2

What are the most pertinent measures that Mohs surgeons can perform to minimize the excision of healthy tissue during the first stage of Mohs excision of melanoma in situ?

The most crucial measure that a Mohs Surgeon can take to minimize the removal of normal healthy tissue is to take small, 2-3 mm layers around the clinically apparent skin cancer, including Melanoma In Situ. When a patient presents with Melanoma In Situ or any skin cancer, the standard of care is to circle the clinically apparent lesion and show this to a patient in a mirror prior to initiating the Mohs procedure.

Q3

Have you reviewed a case similar to the one described above? If so, please briefly describe.

While every case is unique, I have encountered instances where concerns were raised about the extent of tissue excision during Mohs surgery. I would be happy to review this matter further and offer my assistance.

About the expert

This expert is a seasoned dermatologist with over 25 years of experience, specializing in Mohs surgery. They are board-certified in dermatology with a subspecialty in micrographic dermatologic surgery and have completed extensive training and fellowships at renowned medical institutions. Currently serving as the chief of dermatology at a medical center and the surgical director of Mohs micrographic surgery at a surgery center, they also contribute to academia through numerous peer-reviewed publications and previous roles as an associate professor and clinical operations coordinator.

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