Disclaimer: The information contained within the Grand Rounds Archive is intended for use by doctors and other health care professionals. These documents were prepared by resident physicians for presentation and discussion at a conference held at Baylor College of Medicine in Houston, Texas. No guarantees are made with respect to accuracy or timeliness of this material. This material should not be used as a basis for treatment decisions, and is not a substitute for professional consultation and/or peer-reviewed medical literature.Mohs Surgery in the Head and Neck Case Presentation: The patient is a 53-year-old white male who presents after three extensive resections of a nasal basosquamous CA. He was offered reconstruction in the past, but deferred. His nasal defect was covered with a split thickness skin graft. He now presents with a new, non-healing, painless ulcer on the remnant of his nasal dorsum. Past medical history is remarkable for hypertension, obstructive sleep apnea, and left congenital renal agenesis. Past surgical history is as above, as well as turbinate resection and foot surgery. Medicines include Plendil. Social history is remarkable for a 30 pack year and social EtOH.Physical exam shows a fair skinned male in no apparent distress. TM's: clear. Nose: significant soft tissue and cartilage defect of R nasal ala, tip and dorsum with a 0.5 cm ulceration along superior portion of skin graft. OC/OP: clear. Larynx: TVC mobile without lesions. Neck: no LAD. Biopsy of the ulcer showed recurrent basosquamous CA. The patient underwent Mohs micrographic surgery on 12/7/98. Clear margins were obtained, leaving an extensive defect. Definitive reconstruction with a rib graft was discussed but ultimately deferred. A split thickness skin graft was placed. He will be followed closely in the VA clinic for further recurrence, with reconstruction planned in 9-12 months. Bibliography: Bernstein PE. Mohs '98: single-procedure Mohs surgery with immediate reconstruction. Otolaryngol Head Neck Surg 1999;120:184-189.
Cook J, Zitelli JA. Mohs micrographic surgery: a cost analysis. J Am Acad Dermatol 1998;39:698-6703. Davidson TM, Nahum AM, Haghighi P, Astarita R, Saltzstein SL, Seagren S. The biology of head and neck cancer: detection and control by parallel histologic sections. Arch Otolaryngol 1984;110:193-196. Davidson TM, Haghighi P, Astarita R, Baird S, Seagren S. Microscopically oriented histologic surgery for head and neck mucosal cancer. Cancer 1987;60:1856-1861. Davidson TM, Haghighi P, Astarita R, Baird S, Seagren S. MOHS for head and neck mucosal cancer: report on 111 patients. Laryngoscope 1988;98:1078-1083. Grevey SC, Zax RH, McCall MW. Melanoma and Mohs' micrographic surgery. Adv Dermatol 1995;10:175-197. Gross KG, Steinman HK, Rapini RP, editors. Mohs Surgery: Fundamentals and Techniques. Mosby: St. Louis; 1999. Hitchcock MG, Leshin B, White WL. Pitfalls in frozen section interpretation in Mohs micrographic surgery. Adv Dermatol 1998;13:427-462. Holmkvist KA, Roenigk RK. Squamous cell carcinoma of the lip treated with Mohs micrographic surgery: outcome at 5 years. J Am Acad Dermatol 1998;38:960-966. Hruza GJ. Mohs micrographic surgery. Otolaryngol Clin North Am 1990;23:845-864. Lang PG. Mohs micrographic surgery: fresh tissue technique. Dermatol Clin 1989;7:613-626. Mehregan DA, Roenigk RK. Management of superficial squamous cell carcinoma of the lip with Mohs micrographic surgery. Cancer 1990;66:463-468. Mohs FE. Chemosurgery, a microscopically controlled method of cancer excision. Arch Surg 1941;42:279-295. Nelson BR, Railan D, Cohen S. Mohs' micrographic surgery for nonmelanoma skin cancers. Clin Plast Surg 1997;24:705-718. Rowe DE, Carroll RJ, Day CL. Prognostic factors for local recurrence, metastasis and survival rates in squamous cell carcinoma of the skin, ear and lip. J Am Acad Dermatol 1992;26:976-990. Schuller DE, Bier-Laning CM, Sharma PK, Siegle RJ, Pellegrini AE, Karanfilov B, Bellisari G, Miller R, Young DC. Tissue-conserving surgery for prognosis, treatment and function preservation. Laryngoscope 1998;108:1599-1604. Shriner DL, McCoy DK, Goldberg DJ, Wagner RF. Mohs micrographic surgery. J Am Acad Dermatol 1998;39:80-96. Swanson NA, Grekin RC, Baker SR. Mohs surgery: techniques, indications, and applications in head and neck surgery. Head Neck Surg 1983;6:683-692. Swanson NA, Johnson TM. Management of Basal and Squamous Cell Carcinoma. In: CW Cummings CW, et al, editors. Otolaryngology-Head and Neck Surgery. Mosby: St. Louis; 1998. pp. 486-500. Tromovitch TA, Stegman SJ. Microscopically controlled excision of skin tumors: chemosurgery (Mohs) fresh tissue technique. Arch Dermatol 1974;110:231-232. Click here to view slides from this presentation Grand Rounds Archive | Department Home pageBCM Public | BCM Intranet | Privacy Notices | Contact BCM | BCM Site Map | ©2001-2006 Baylor College of Medicine
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