INTRODUCTION
Single-section Mohs (SSM) allows for the most accurate histological representation of tissue’s in vivo architecture during Mohs Micrographic Surgery (MMS).1 Traditional debulking involves pre-surgical curettage and taking tumor layers using a 45-degree bevel. In comparison, some surgeons perform sharp debulking with a scalpel along with bevel angles as high as 90 degrees.2 It is unclear if these debulking preferences impact surgical outcomes, particularly the number of layers required to complete a case (compared with the average of 1.74 layers per case recently reported across all Mohs surgeons).3 The purpose of the study was to establish a current cross-sectional view of the preferences for tumor debulking and histological tissue preparation among practicing Mohs surgeons.
An Institutional Review Board (IRB) and American College of Mohs Surgery (ACMS) approved survey was created to establish current debulking preferences when performing MMS and sent to ACMS-fellowship trained Mohs surgeons. Comparisons were made between debulking preferences and provider demographics using t-tests and fisher exact tests (P<0.05 considered statistically significant).1
A total of 96 Mohs surgeons completed the survey (74% in a private setting), with 73% reporting average layers per MMS case of under 1.7 (Table 1). Tumor debulking of any type was performed in 75.5% of cases with no differences between practice setting or years of experience. Curettage debulking was used more often than sharp debulking (51% vs 30% of respondents reporting its use). Using a 45-degree bevel to take tumor layers was used by 78.7% of respondents (with the remaining surgeons preferring a 90-degree bevel; Table 1).
SSM was utilized by 61% of Mohs surgeons (87.0% with a 45-degree bevel and 13.0% with a 90-degree bevel; Table 1). In comparison, multi-section Mohs was utilized by the remaining 39% of respondents (70.4% of these surgeons a 45-degree bevel and 29.6% with a 90-degree bevel). Fifty-nine percent of those who sharp debulk utilize SSM compared with 52% of those who debulk with a curette (P=0.6298). Eighty-seven percent of surgeons who curette debulk use 45-degree bevel angles to take layers compared with 74.5 % of those who use sharp debulking (P=0.1229).
An Institutional Review Board (IRB) and American College of Mohs Surgery (ACMS) approved survey was created to establish current debulking preferences when performing MMS and sent to ACMS-fellowship trained Mohs surgeons. Comparisons were made between debulking preferences and provider demographics using t-tests and fisher exact tests (P<0.05 considered statistically significant).1
A total of 96 Mohs surgeons completed the survey (74% in a private setting), with 73% reporting average layers per MMS case of under 1.7 (Table 1). Tumor debulking of any type was performed in 75.5% of cases with no differences between practice setting or years of experience. Curettage debulking was used more often than sharp debulking (51% vs 30% of respondents reporting its use). Using a 45-degree bevel to take tumor layers was used by 78.7% of respondents (with the remaining surgeons preferring a 90-degree bevel; Table 1).
SSM was utilized by 61% of Mohs surgeons (87.0% with a 45-degree bevel and 13.0% with a 90-degree bevel; Table 1). In comparison, multi-section Mohs was utilized by the remaining 39% of respondents (70.4% of these surgeons a 45-degree bevel and 29.6% with a 90-degree bevel). Fifty-nine percent of those who sharp debulk utilize SSM compared with 52% of those who debulk with a curette (P=0.6298). Eighty-seven percent of surgeons who curette debulk use 45-degree bevel angles to take layers compared with 74.5 % of those who use sharp debulking (P=0.1229).
