An Introduction to Mohs Micrographic Surgery

Abstract

The founding father of Mohs micrographic surgery is Frederic E. Mohs. He was only a medical student when he began to develop his new surgical technique during the 1930s. Mohs noticed that zinc chloride could be used to “fix” a tumor so that the histologic architecture could be viewed under a microscope. In 1936, Mohs translated his research method into use for cutaneous tumors in humans. It was at this time that chemosurgery (the precursor to modern day Mohs micrographic surgery) was born. In 1941, Mohs reported his findings using fixed tissue chemosurgery in the Archives of Surgery with 440 patients. Later in 1946, he reported more results at the American Academy of Dermatology in Chicago. In 1947, he described his technique and work in the Archives of Dermatology. In 1953, Mohs was creating a video illustrating the chemosurgery technique for the eyelid. In order to speed the surgery for the video, he did not use the zinc chloride fixative. Instead, he used fresh frozen tissue to generate the horizontal sections. Hence, the birth of the present day form of Mohs Micrographic Surgery began taking shape. In 1983, the first 1-year fellowship program was formally approved by the American College of Mohs Micrographic Surgery and Cutaneous Oncology (ACMMSCO). Fourteen years after the approval of the first fellowship program, there were more than 60, 1–2-year training programs approved by the ACMMSCO. In addition, there are approved fellowships in Australia, New Zealand, and Canada. Mohs surgery is spreading across the world, and we have dedicated an entire section of this book to document its travel.