Journal Information
Vol. 95. Issue 4.
Pages 546-547 (01 July 2020)
Visits
4124
Vol. 95. Issue 4.
Pages 546-547 (01 July 2020)
Correspondence
Open Access
On the different methods of micrographic surgery and their differences in the visualization of the tumor and surgical margin, and in the contribution to clinical and oncological aspects
Visits
4124
Sandro Simão Corrêa Filho
Private Clinic, Blumenau, SC, Brazil
This item has received

Under a Creative Commons license
Article information
Full Text
Bibliography
Download PDF
Statistics
Tables (1)
Table 1. Comparison between some characteristics of the Munich method and peripheral methodsa
Full Text
Dear Editor,

Micrographic surgery was developed in the 1930s by Dr. Friedrich Mohs, using the in vivo tissue fixation method. In 1970, Stegman and Tromovitch published a series of cases using ex vivo fixation. In 1995, the Munich method was described.

Since then, surgeons have been constantly learning these techniques.1–4

In the study by Portela et al.5 a new form of debulking assessment was described, but it is identical to the Munich method previously described in the literature. The concepts of margin and surgical border are imprecise. The authors illustrate an essential feature of the Munich method: the possibility of assessing the tumor–surgical margin relationship and observation of the tumor. Thus, it is possible to better demonstrate the subtype, cytological aspects, and tumor architecture, which have clinical and oncological relevance and are important for decision making. These factors gain importance in tumors with rarer histology and with greater metastatic potential; it also facilitates the identification of perineural invasion. In turn, peripheral methods evaluate only the surgical border, and do not observe the tumoral core. Although bread-loafing of the paraffin block is performed during debulking, the sample is smaller and the results are not available in the trans-operative period, given the time required for paraffin embedding and processing. A drawback of the fresh method is the greater chance of technical artifacts (Table 1).

Table 1.

Comparison between some characteristics of the Munich method and peripheral methodsa

  Munich method  Peripheral methods (Mohs, Tübingen, muffin) 
Observation of the tumor core  Yes  No 
Tumor analysis  Yes  No (only if there is tumor involvement of the surgical border) 
Evaluation of the cutaneous tumor siteb  Yes  No 
Observation of the tumor-surgical margin relationship  Yes  No 
Analysis of tumor cytology (e.g., mitotic figures)  Yes  No (only if there is tumor involvement of the surgical border) 
Assessment of perineural involvement  Easier  More difficult 
Number of glass slides  Greater  Smaller 
a

Even if a previous biopsy of the affected area is performed, there may be a discrepancy between the data from the incisional biopsy and the posterior excision due to sampling, as pointed out by Portela et al.5

b

Important in ill-defined tumors or scars.

The author of this correspondence highlights the importance of broadening the discussion of the technical and laboratory details of the various forms of micrographic surgery, including the implications of each technique for the clinical and oncological data.

Financial support

None declared.

Author's contributions

Sandro Simão Corrêa Filho: Approval of the final version of the manuscript; conception and planning of the study; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript.

Conflicts of interest

None declared.

References
[1]
L.F.F. Kopke, P.S. Gouvea, J.C.F. Bastos.
A ten-year experience with the Munich method of micrographic surgery: a report of 93 operated cases.
An Bras Dermatol, 80 (2005), pp. 583-590
[2]
O. Arnon, R.P. Rapini, A.J. Mamelak, L.H. Goldberg.
Mohs micrographic surgery: current techniques.
Isr Med Assoc J, 12 (2010), pp. 431-435
[3]
L.F.F. Kopke, B. Konz.
Essential differences between the variations of micrographic surgery.
An Bras Dermatol, 69 (1994), pp. 505-510
[4]
R.P. Rapini.
Pitfalls of Mohs micrographic surgery.
J Am Acad Dermatol, 22 (1990), pp. 681-686
[5]
P.S. Portela, D.A. Teixeira, C.D.A.S. Machado, M.A.S. Pinhal, F.M. Paschoal.
Horizontal histological sections in the preliminary evaluation of basal cell carcinoma submitted to Mohs micrographic surgery.
An Bras Dermatol, 94 (2019), pp. 671-676

How to cite this article: Corrêa Filho SS. On the different methods of micrographic surgery and their differences in the visualization of the tumor and surgical margin, and in the contribution to clinical and oncological aspects. An Bras Dermatol. 2020;95:546–7.

Study conducted at the Private Clinic, Blumenau, SC, Brazil.

Copyright © 2020. Sociedade Brasileira de Dermatologia
Idiomas
Anais Brasileiros de Dermatologia
Article options
Tools
en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.