On variations in micrographic surgery and the use of horizontal histological sections in the evaluation of the surgical margin

Complete microscopic control of the excisional margins remains the most effective method for treating non-melanoma skin tumors. Since the original idea of chemosurgery was developed by Frederic Mohs, in the 1930s, there has been substantial development of techniques for incision, inclusion, and processing of histological specimens, sectionning techniques, histological markings, and evaluation of margins. This has allowed the performance of these procedures in an outpatient setting, reducing operational time, minimizing resection of healthy tissue adjacent to the neoplasm, and reducing the cost and number of stages of surgery. The fundamental difference between variations in micrographic surgery is the form of inspection of the involved surgical margin. Peripheral analysis techniques (e.g., Mohs surgery, Tübingen, the muffin technique) assess the presence of tumor cells in the hypothetical surgical border. Central analysis techniques (e.g., Munich), assess the entire neoplasia and its relationship with the actual surgical borders, based on the integral analysis of the excised tumor tissue sample. Portela et al. presented a technique of horizontal sectionning of the excised tissue, aiming to assess the margin compromise prior to the execution of the Mohs surgery. However, such an approach corresponds exactly to the Munich technique, described in 1995 and disseminated especially in Europe, but mentioned extensively in micrographic surgery articles, whose historical relevance cannot be disregarded. It should be noted that the authors make well-founded criticisms of the Mohs technique and perceive the benefits of