Reconstruction Department: Mohs Micrographic Surgery: Reconstruction and Nursing Considerations for Nonmelanoma Skin Cancers
Susan Lamp BSN, RN, CPSN

$3.95 		Plastic Surgical Nursing
September 2011 
Volume 31  Number 3
Pages 126 - 128
 
  PDF Version Available!

ABSTRACT
Nonmelanoma skin cancers are the most common malignancies and their incidence is increasing. Twenty percent of the U.S. population will develop this type of cancer during their lifetime. The ratio of basal cell carcinoma (BCC) to squamous cell carcinoma (SCC) is 4:1. The concept of sequential tumor removal was originated by Frederick E. Mohs in the early 1930s. His method of excising the cancer under microscopic control resulted in remarkably high cure rates. The residual defect then requires consideration for the type of needed reconstruction. Nursing care and consideration of the multiple factors involved in the care of the patient undergoing reconstruction are discussed.Indications for Mohs surgery include recurrent, higher-risk NMSC (morpheaform BCC and high-risk SCC) and lesions in aesthetically sensitive areas (nose, eyelid, lip, etc.).Advantages are tissue preservation and confirmation of complete excision (Brown & Borschel, 2004).The concept of sequential tumor removal was originated by Frederic E. Mohs, while working as a cancer research assistant during medical school in the early 1930s. While testing the irritant effect of an injected 20% zinc chloride solution upon transplantable cancers, Mohs noted that the treated tissue maintained its normal microscopic architecture as if it had been immersed in a fixative solution. This observation initiated the idea of excising cancer under microscopic control. The procedure, appropriately named chemosurgery by its inventor, began with the overnight application of a zinc chloride paste to the tumor. The next day, a saucer-shaped sample of tissue was excised painlessly in a blood-free field. After manipulating the specimen so that the periphery of the excised tissue was in a single horizontal plane, frozen sections were obtained that permitted greater inspection of the surgical margin than traditional methods of surgical margin evaluation. Precise mapping of the tissue border allowed the surgeon to return to the exact

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