Tumor Detection After Inflammation or Fibrosis on Mohs Levels

Abstract

BACKGROUND: In Mohs micrographic surgery (MMS), many surgeons will take an additional level based solely on the presence of inflammation or fibrosis. OBJECTIVE: To determine the frequency with which this occurs and parameters predicting tumor discovery on successive levels. MATERIALS AND METHODS: A retrospective study was performed on 22,419 cases treated with MMS between 1996 and May 2011. The surgeons reviewed their own slides in cases where tumor was detected after a level was taken for inflammation or fibrosis. RESULTS: An additional level was taken for inflammation or fibrosis in 6,233 cases (27.8%), resulting in tumor detection in 121 cases (1.9%). Additional levels were taken for inflammation in 66.6% and fibrosis in 63.0%. Fourteen collision tumors were identified and were preceded by inflammation in 71% of cases. DISCUSSION: Factors that may predict the presence of tumor at subsequent levels include eccentrically placed or shallow first levels failing to completely encompass a previous surgical scar. The presence of dense inflammation may signal an adjacent collision tumor. CONCLUSION: Taking an additional Mohs level when dense inflammation or fibrosis is present may be warranted to ensure complete tumor removal.