INTRODUCTION
Mohs micrographic surgery (MMS) has emerged as a highly effective and precise treatment for skin cancer, offering exceptional cure rates while preserving healthy tissue.1 MMS involves the sequential removal of horizontal layers of the tumor, which are processed in real time to determine if the margins are cancer-free.2 This stepwise approach is designed to maximize the conservation of healthy tissue by allowing the surgeon to suspend tissue removal once cancer-free margins are detected.2 The American Academy of Dermatology has determined guidelines for excision and management by MMS with the appropriate use criteria (AUC). Some examples of AUC for MMS include tumor recurrence, aggressive histology, and anatomic location.3
MMS has been used to treat various vulvar and perineal cancers, such as squamous cell carcinoma (SCC), basal cell carcinoma (BCC), Extramammary Paget's disease (EMPD), and dermatofibrosarcoma protuberans (DFSP).4 However, female cutaneous genital cancers have historically been managed with methods such as partial or total vulvectomy, or wide local excision (WLE) with consideration of lymph node dissection based on dermal invasion and probability of metastasis.5 The anatomy of the female genitalia poses unique challenges for surgical management, particularly in cancer cases. The vulva is a complex structure with histologically diverse tissue types, including keratinized epithelium, non-keratinized mucosa, and underlying connective tissue.6 There are many critical structures in close proximity within the female genital region, including the urethra, anal sphincter, and clitoris. These are often located extremely close to potential tumor sites; therefore, surgical precision is of utmost importance to avoid damage that could compromise urinary or fecal continence, sexual function, and sensory integrity of the area.7 Thus, when compared to conventional approaches like vulvectomy, MMS potentially offers the benefits of maximizing tissue conservation for more superficial skin cancers where lymph node biopsy or dissection is not indicated.
While there has been increasing evidence on the utility of MMS in female genital cancers, limited consolidated research on these methods remains, as delineated by a previous systematic review on vulvar malignancies.8 This systematic review aims to synthesize and evaluate recent literature on the application and utility of MMS in the management of female genital cancers.
MMS has been used to treat various vulvar and perineal cancers, such as squamous cell carcinoma (SCC), basal cell carcinoma (BCC), Extramammary Paget's disease (EMPD), and dermatofibrosarcoma protuberans (DFSP).4 However, female cutaneous genital cancers have historically been managed with methods such as partial or total vulvectomy, or wide local excision (WLE) with consideration of lymph node dissection based on dermal invasion and probability of metastasis.5 The anatomy of the female genitalia poses unique challenges for surgical management, particularly in cancer cases. The vulva is a complex structure with histologically diverse tissue types, including keratinized epithelium, non-keratinized mucosa, and underlying connective tissue.6 There are many critical structures in close proximity within the female genital region, including the urethra, anal sphincter, and clitoris. These are often located extremely close to potential tumor sites; therefore, surgical precision is of utmost importance to avoid damage that could compromise urinary or fecal continence, sexual function, and sensory integrity of the area.7 Thus, when compared to conventional approaches like vulvectomy, MMS potentially offers the benefits of maximizing tissue conservation for more superficial skin cancers where lymph node biopsy or dissection is not indicated.
While there has been increasing evidence on the utility of MMS in female genital cancers, limited consolidated research on these methods remains, as delineated by a previous systematic review on vulvar malignancies.8 This systematic review aims to synthesize and evaluate recent literature on the application and utility of MMS in the management of female genital cancers.
