MOC-PSSM CME Article: Nonmelanoma Facial Skin Malignancy

In Brief Learning Objectives: After studying this article, the participant should be able to: 1. Identify the environmental and genetic risk factors in developing nonmelanoma facial skin malignancy. 2. Understand the proper evaluation of a patient presenting with nonmelanoma facial skin malignancy. 3. Outline the various treatment options available for patients with nonmelanoma facial skin malignancy and understand the specific technique of Mohs’ micrographic surgery versus surgical excision with frozen section control. 4. Describe the various options for reconstruction and the associated anesthetic requirements. Background: The incidence of nonmelanoma facial skin malignancy is rising dramatically. Physicians should be well versed on the appropriate methodology required to both evaluate and treat these patients. Methods: A literature review was performed regarding the evaluation and various management options for patients with nonmelanoma facial skin malignancy. Specific attention was paid to the Mohs’ technique versus surgical excision with frozen section control for treatment of these patients. Results: An algorithm is presented regarding the appropriate assessment and treatment of patients with nonmelanoma facial skin malignancy. Comparison of the Mohs’ technique with frozen section control showed potentially similar disease-free outcomes. However, the lack of adequate scientific studies for surgical excision with frozen section control was identified. Conclusions: Various treatment algorithms exist for nonmelanoma facial skin malignancy. Consideration must be given by the physician to patient comorbidities, anesthesia requirements, appropriate monitoring, and cost of excision. The Maintenance of Certification module series is designed to help the clinician structure his or her study in specific areas appropriate to his or her clinical practice. This article is prepared to accompany practice-based assessment of preoperative assessment, anesthesia, surgical treatment plan, perioperative management, and outcomes. In this format, the clinician is invited to compare his or her methods of patient assessment and treatment, outcomes, and complications with authoritative, information-based references. This information base is then used for self-assessment and benchmarking in parts II and IV of the Maintenance of Certification process of the American Board of Plastic Surgery. This article is not intended to be an exhaustive treatise on the subject. Rather, it is designed to serve as a reference point for further in-depth study by review of the reference articles presented. MOCERT AVAILABLE AT http://www1.plasticsurgery.org/ebusiness4/OnlineCourse/CourseInfo.aspx?Id=14000.