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Presentation

Pearls for Challenging Mohs Stages

Description

In this session, the speaker discusses the nuances of handling challenging stages in Mohs micrographic surgery, sharing insights based on their decade-long practice. They emphasize understanding anatomy and the importance of careful preparation, particularly in delicate procedures involving the eyelid and ear. The speaker provides an overview of various surgical techniques, such as using plastic eye shields and specific instruments to avoid damaging surrounding tissues, particularly around the eyelid margin and the midface. They also touch on the importance of recognizing critical anatomical structures like the medial canthal tendon and superficial temporal nerve to prevent complications. Tips for dealing with ear tumors include using proper antiseptics and dental rolls for better access and visualization. Furthermore, the presentation advises on managing potential complications such as air embolism during deep resections by positioning the patient appropriately and using sealing techniques for exposed bone. Overall, the message is that mastery in surgical challenges can be achieved through decomposing complex tasks into manageable steps, with a strong focus on anatomical knowledge and patient safety.

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Conclusions

Understanding the anatomy of surgical areas like the eyelid and ear is critical for successful interventions.
Using proper surgical techniques and instruments, such as eye shields and specific scissors, enhances surgical safety and effectiveness.
Recognizing the importance of anatomical structures can prevent complications during surgery.
Surgeons should balance achieving clear margins with minimizing the risk of damaging crucial nerves during resections.
Patients need to be informed about potential risks, including nerve damage, especially during deep surgical procedures.
Utilizing staining techniques like methylene blue can help delineate surgery planes and improve excision completeness.
Air embolism is a serious risk during procedures involving the periosteum, necessitating careful patient positioning and technique to mitigate this risk.
Covering exposed bone and using proper sealing techniques post-surgery is important for graft survival and preventing complications.

Stiegel E et al. Mohs Micrographic Surgery Pearls for the Nose and Lips. Dermatol Surg. 2019;45:S99-S109.
McCallister M, Krishnan R, Desai R. Obtaining Thin and Complete Mohs Layers Using the Methylene Blue Staining Technique.
Development of Cerebral Air Emboli During Mohs Micrographic Surgery. Dermatologic Surgery: September 2009 - Volume 35 - Issue 9 - p 1414-1421.
Local Flaps in Facial Reconstruction, 3rd Edition, Elsevier Saunders. 2014.