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A special kind of skin cancer surgery, named Mohs micrographic surgery (or Mohs surgery), was invented by a University of Wisconsin Otolaryngologist, Dr. Frederick Mohs [1]. The initial Mohs surgery procedure, also called chemosurgery, employed a zinc chloride-containing chemical paste to destroy cancerous tissue layer by layer under microscopic control [1]. The procedure was subsequently modified to the current and well-accepted form, where patients affected by non-melanoma skin cancers of certain facial locations, recurrent skin cancers, or skin cancers with certain aggressive histologic features would be treated by a layered excisional procedure without the pain associated with zinc chloride paste [2]. The current procedure, with the ability to determine cancer margin in an intraoperative fashion, utilizes microscopic examinations of stained frozen sections obtained from an excised layer of orientation-marked skin where the clinical cancer is visually observed, while the patient waits for the result. Microscopic identification of cancer at the margin of excised skin layer will necessitate the return of the patient to the surgical table for addition layer of excision [3]. The process repeats if needed, until all margins are clear of skin cancer, at which point the Mohs surgeon will close the wound defect, commonly utilizing adjacent tissue transfer technique called flap [4].

Mohs Micrographic Surgery Sine Microscopy: Is mass spectrometry an upcoming intraoperative cancer margin assessment tool?