DS18 Pre-Mohs biopsy survey (related specifically to basal cell carcinoma and biopsy prior to Mohs surgery)

Mohs micrographic surgery (MMS) is a specialized surgical technique for removing locally invasive, high-risk skin cancers. MMS provides high cure rates with maximal preservation of unaffected tissue (Hanke CW. Frederic Mohs tribute. History of Mohs micrographic surgery. J Drugs Dermatol 2002; 1: 169–74; Brodland DG, Amonette R, Hanke CW, Robins P. The history and evolution of Mohs micrographic surgery. Dermatol Surg 2000; 26: 303–7). In contrast to standard excision, in which only a small portion of the margins is evaluated, in MMS, specimens are cut in horizontal sections that allow the evaluation of the entire peripheral and deep margins of the tumour. This survey was conducted to gather different opinions about type of biopsies used before Mohs surgery specifically for basal cell carcinoma (BCC). The survey was sent to British Society for Dermatological Surgery members all over the UK. The survey aimed to investigate participants’ opinions in doing biopsies before Mohs surgery specifically for BCC. This includes the types of the biopsy they prefer, and how it affects the Mohs procedure, for example whether there is a specific type of biopsy that results in the need to take more deep levels during the Mohs procedure. Of the responses received, 60% were from dermatology consultants, about half of whom are Mohs surgeons. Overall, we found that about 50% do routine biopsy before Mohs, 65% prefer scoop biopsy or shave biopsy and only 10% do punch biopsy, while 15% do not mind the type of the biopsy. We were interested that 50% routinely do biopsies prior to Mohs, and of these at least 10% are punch biopsies, which we feel should be limited as they can induce a deep scar and result in more layers being taken during the Mohs surgery procedure in order to clear the scar.