Mohs Micrographic Surgery

Mohs Micrographic Surgery (MMS) is resource intensive and generates a significant amount of anxiety for the patient.

Surgeon, MMS staff and the patient can benefit from the imaging capabilities of VivoSight to better evaluate the lesion to be treated.

Redrawn initial excision perimeter on elderly male after VivoSight imaging

Lesion Imaging Prior to Mohs Surgery

  • Draw perimeter around clinical lesion including usual margin
  • Observe shadow of margin marker in OCT image
  • Assess whether (BCC) lesion is inside or outside margin border and redraw margin accordingly if needed. Images courtesy of Welzel [1]
Case 1a: mark lesion initially with special pen casting a strong OCT shadow
Case 1b: observe shadow in OCT
Case 1c: note signs of BCC outside initial margin (red arrows on right)
Case 2a: Assessing margin mapped images
Case 2b: Margin not correctly placed. BCC lesion inside and outside marked margin perimeter

Assessing a tumor margin with VivoSight is an easy to implement procedure:

Step 1: The probe is placed at 12 o’clock position with the scan straddling the pen mark. (Blue line shows scan orientation).
Step 2: The tumor was observed in OCT outside the pen mark, so a new pen mark was drawn and the margin re-scanned.
Step 3: Next, the probe is moved towards the 3 o’clock position and margin is re-checked
Step 4: This procedure is repeated until the whole tumor margin has been checked to be inside the pen mark

References:

1. Schuh S., Welzel J. (2020) OCT-Guided Laser Treatment and Surgery. In: Bard R. (eds) Image Guided Dermatologic Treatments. Springer, Cham

2. De Carvalho N, Schuh S, Kindermann N, Kästle R, Holmes J, Welzel J. Optical coherence tomography for margin definition of basal cell carcinoma before micrographic surgery—recommendations regarding the marking and scanning technique. Skin Res Technol. 2017;00:1–7. https://doi.org/10.1111/srt.12407R

3. Markowitz O, Siegel D, Fisher J. Clinical Utility of Bedside Multibeam Optical Coherence Tomography Imaging in a Patient With Multiple Basal Cell Carcinomas. Dermatol Surg 2017;0:1–3

4. Markowitz O, Psomadakis CE. Patient-driven management using same-day noninvasive diagnosis and complete laser treatment of basal cell carcinomas: a pilot study. Cutis. 2019 Dec;104(6):345-348;350;351;E1;E2.

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