ABD Mohs Surgery flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Mohs margin assessment

Complete examination of 100% of the peripheral and deep margins by mapping and frozen-section histology, enabling tissue-sparing excision with high cure rates.

Basal cell carcinoma subtypes

Nodular and superficial subtypes are low-risk; morpheaform, infiltrative, micronodular, and basosquamous subtypes show aggressive subclinical extension and higher recurrence.

Perineural invasion

Tumor tracking along nerve sheaths, associated with higher recurrence and metastasis; named-nerve involvement may require imaging and multidisciplinary management.

Breslow thickness

Depth of melanoma invasion measured in millimeters from the granular layer to the deepest tumor cell; a key prognostic factor in AJCC staging.

Dermatofibrosarcoma protuberans

Locally aggressive spindle-cell tumor with storiform pattern and subclinical extension; CD34 positive and best treated with Mohs surgery.

Debulking specimen

Initial central tumor removal during Mohs sent for permanent section to confirm diagnosis and assess deepest invasion before margin excision.

Relaxed skin tension lines

Lines of minimal skin tension that guide incision orientation to optimize scar appearance and reduce wound tension.

Frozen section thickness

Sections cut at 4–6 micrometers; thicker sections reduce nuclear detail and increase the risk of false-negative margin interpretation.

Peripheral palisading

Peripheral arrangement of basaloid cells characteristic of basal cell carcinoma on histopathology, often with stromal retraction artifact.

Storiform pattern

Cartwheel-like arrangement of spindle cells seen in dermatofibrosarcoma protuberans and some other fibrous tumors.

Margin positivity

Tumor present at the inked surgical margin; close margins within one high-power field often prompt additional excision.

Fusiform closure ratio

Elliptical excision with length-to-width ratio of 3:1 to 4:1 oriented along relaxed skin tension lines to minimize dog-ear formation.

Rhomboid flap

Limberg transposition flap using 60/120-degree angles to redistribute tension in a defect, commonly used on the face.

Full-thickness skin graft

Graft containing epidermis and dermis requiring a well-vascularized bed; poor take over cartilage or irradiated tissue.

Suture removal timing

Face 5–7 days, scalp 7–10 days, trunk and extremities 10–14 days; tension-bearing areas require longer intervals.

Lidocaine maximum dose

7 mg/kg without epinephrine and 4.5 mg/kg with epinephrine; exceeding doses risks local anesthetic systemic toxicity.

Anticoagulation in Mohs

Warfarin and direct oral anticoagulants are generally continued during Mohs because stopping increases thromboembolic risk more than bleeding risk.

Keloid versus hypertrophic scar

Keloids extend beyond the original wound and recur; hypertrophic scars remain within the wound and often regress; intralesional steroid is first-line.

Vasovagal syncope

Transient hypotension and bradycardia during injection or procedure; managed with supine positioning, monitoring, and supportive care.

Marginal mandibular nerve

Facial nerve branch running near the mandibular border; injury causes asymmetric smile and lower lip depression.

Danger triangle of face

Region drained by the angular vein to the cavernous sinus; infection can spread intracranially and warrants prompt treatment.

Eyelid lamellae

Anterior lamella comprises skin and orbicularis; posterior lamella comprises tarsus and conjunctiva; defects over 50% of the margin need reconstruction.

Neck nodal levels

Level I submental and submandibular; level II upper jugular; levels III–VI descend the neck and guide staging and dissection.

Appropriate use criteria

Scoring system that guides selection of Mohs versus excision based on tumor, patient, and site factors.

Surgical time-out

Pre-incision verification of patient identity, site, and procedure by the team to prevent wrong-site errors.

Specimen chain of custody

Unique identifiers and map documentation tracking each Mohs stage from excision through pathology to prevent specimen mix-ups.

Mohs CPT coding

Codes reflect number of stages and repair or graft type; documentation must match the operative note to support medical necessity.

Informed consent elements

Disclosure of risks, benefits, alternatives, and the right to refuse; documented before the procedure.

HIPAA minimum necessary

Standard requiring disclosure of only the minimum protected health information needed for the purpose.

Conflict of interest

Financial or personal relationships that could bias clinical or billing decisions; must be disclosed to patients and institutions.

Upcoding

Billing for a higher-complexity service than performed; a form of fraud that violates ethical and legal standards.

Patient photograph privacy

Clinical images are protected health information; de-identification is required before publication or teaching use.