Beyond DFSP: A Review of Mohs Surgery Across Rare Pediatric Dermatologic Tumors

Mohs micrographic surgery (MMS) is a cornerstone in adult dermatologic oncology, yet its application in pediatric patients remains rare and understudied. While dermatofibrosarcoma protuberans (DFSP) is the most commonly cited pediatric tumor treated with MMS, a growing body of case reports suggests that other rare, margin-sensitive tumors may also benefit from this tissue-sparing approach. This review synthesizes individual patient data across a national sample of pediatric MMS cases for tumors beyond DFSP, including basal cell carcinoma, microcystic adnexal carcinoma, granular cell tumors, and adnexal carcinomas. Ten original case reports were identified and extracted, each providing detailed demographic, tumor, procedural, and outcome characteristics. Patient ages ranged from 5 to 18 years, with equal gender distribution. All tumors were located on high-risk anatomical sites such as the head, neck, or foot. Syndromic associations, particularly xeroderma pigmentosum, were present in a subset. Most procedures required general anesthesia due to patient age and lesion location. The number of Mohs stages ranged from one to three stages where reported. Margin control was consistently achieved, and complications were rare. Cosmetic outcomes were inconsistently reported, though generally favorable. These findings suggest that MMS may be underutilized in rare pediatric dermatologic tumors where margin control and tissue preservation are critical. This is the first review to consolidate such cases across diverse tumor types, offering a foundational taxonomy to guide clinical decision-making for Mohs use beyond DFSP in children.