204: Mohs Micrographic Surgery

Question 1

What is the fundamental advantage of Mohs Micrographic Surgery (MMS)?

Answer 1

The fundamental advantage of MMS is the microscopic analysis of the complete surgical margin.

Question 2

How does beveled excision in Mohs surgery differ from standard excision?

Answer 2

Beveled excision in Mohs surgery examines the entire deep and peripheral surgical margin in a single plane, while standard excision does not provide this comprehensive analysis.

Question 3

What is the typical setting for performing Mohs surgery?

Answer 3

Mohs surgery is usually performed as an office-based procedure under local anesthesia.

Question 4

What is the importance of histopathologic analysis in Mohs surgery?

Answer 4

Histopathologic analysis is crucial as it relies on accurate interpretation of margin status and optimal histologic processing with robust quality control to ensure successful outcomes.

Question 5

What is the typical angle used for tangential or beveled excision in Mohs surgery?

Answer 5

The typical angle used for tangential or beveled excision in Mohs surgery is 45 degrees.

Question 6

What is the role of histopathologic analysis in Mohs surgery?

Answer 6

Histopathologic analysis in Mohs surgery is crucial for determining margin status and ensuring that all cancerous cells are removed, which is essential for successful treatment outcomes.

Question 7

What type of anesthesia is typically used during Mohs surgery?

Answer 7

Mohs surgery is usually performed under local anesthesia, allowing for patient comfort during the procedure.

Question 8

What is the significance of en face sections in Mohs surgery?

Answer 8

En face sections are significant in Mohs surgery because they allow for the examination of the entire surgical margin in a single plane, improving the accuracy of margin assessment.

Question 9

What are the implications of false-negative surgical margins in Mohs surgery?

Answer 9

False-negative surgical margins can lead to incomplete removal of cancerous tissue, increasing the risk of recurrence and necessitating further treatment.

Question 10

What factors contribute to the success of Mohs surgery?

Answer 10

The success of Mohs surgery relies on: 1. Accurate interpretation of histopathologic margin status 2. Optimal histologic processing 3. Robust quality control.

Question 11

Why is Mohs surgery considered the standard of care for BCC and SCC in certain cases?

Answer 11

Mohs surgery is considered the standard of care for Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC) with a high risk of recurrence or in sensitive anatomic locations due to its ability to ensure complete tumor removal while preserving surrounding healthy tissue.

Question 12

What is the importance of quality control in the histologic processing of tissue in Mohs surgery?

Answer 12

Quality control in histologic processing is important in Mohs surgery to ensure that the tissue is processed accurately, which is critical for the reliable interpretation of margins and ultimately affects the success of the surgery.

Question 13

What are the risk factors that would predict microscopic tumor extension in a patient with BCC on the nose?

Answer 13

Risk factors include poorly defined clinical margins, diameter greater than 2 cm, and location on the high-risk ‘H’ zone of the face, which includes the nose.

Question 14

What are the recommended surgical margins for nodular and infiltrative/micronodular basal cell carcinoma (BCC)?

Answer 14

The recommended surgical margins are: - 4 mm for nodular BCC - 5-10 mm for infiltrative and micronodular BCC, which may require excision of underlying muscle, cartilage, and periosteum.

Question 15

What is the long-term recurrence rate for primary and recurrent basal cell carcinoma (BCC) with high-risk features?

Answer 15

The long-term recurrence rates are: - 1-4% for primary BCC with high-risk features - 4-8% for recurrent BCC.

Question 16

How does Mohs surgery compare to standard excision in terms of recurrence rates for basal cell carcinoma (BCC)?

Answer 16

Mohs surgery results in a recurrence rate that is 3-4 fold lower than standard excision for both primary and recurrent BCC.

Question 17

What factors are associated with adverse outcomes in squamous cell carcinoma (SCC)?

Answer 17

Four factors strongly associated with adverse outcomes in SCC include: 1. Diameter greater than 2 cm 2. Depth of invasion below subcutaneous adipose 3. Perineural invasion 4. Poor histologic differentiation.

Question 18

What is the recurrence rate for primary squamous cell carcinoma (SCC) after standard excision compared to Mohs surgery?

Answer 18

The recurrence rates are: - Up to 8.1% after standard excision - 3.1% after Mohs surgery.

Question 19

What is the significance of perineural invasion in squamous cell carcinoma (SCC)?

Answer 19

SCC with perineural invasion was found to metastasize in 47% of cases after standard excision compared with 8.3% of cases after Mohs surgery, indicating a higher risk of metastasis with perineural invasion.

Question 20

What factors would increase the risk of local recurrence and nodal metastasis in a patient with SCC on the ear?

Answer 20

Factors include diameter greater than 2 cm, depth of invasion below subcutaneous adipose, perineural invasion, and poor histologic differentiation.

Question 21

What is the recurrence rate for primary SCC treated with Mohs compared to standard excision?

Answer 21

The recurrence rate for primary SCC is up to 8.1% after standard excision and 3.1% after Mohs surgery.

Question 22

What is the appropriate surgical margin for nodular BCC?

Answer 22

The appropriate surgical margin for nodular BCC is 4 mm.

Question 23

Why might Mohs surgery be particularly beneficial for a patient with SCC on the lip?

Answer 23

Mohs surgery is beneficial due to the increased risk of subclinical extension and incomplete excision in SCC, especially in high-risk locations like the lip and in immunosuppressed patients.

Question 24

What is the long-term recurrence rate for primary BCC with high-risk features treated with Mohs?

Answer 24

The long-term recurrence rate for primary BCC with high-risk features treated with Mohs is 1-4%.

Question 25

What is the recurrence rate for previously treated SCC after Mohs compared to standard excision?

Answer 25

The recurrence rate for previously treated SCC is 23.3% after standard excision and 10% after Mohs surgery.

Question 26

What are the four factors strongly associated with adverse outcomes in SCC?

Answer 26

The four factors are diameter greater than 2 cm, depth of invasion below subcutaneous adipose, perineural invasion, and poor histologic differentiation.

Question 27

Why might Mohs surgery be particularly beneficial for a patient with a 3 cm SCC on the lip?

Answer 27

Mohs surgery is beneficial due to the increased risk of subclinical extension and incomplete excision in SCC, especially in high-risk locations like the lip.

Question 28

What are the recommended surgical margins for nodular and infiltrative/micronodular basal cell carcinoma (BCC)?

Answer 28

- Nodular BCC: 4 mm - Infiltrative and Micronodular BCC: 5-10 mm; more likely requires excision of underlying muscle, cartilage, and periosteum.

Question 29

What is the long-term recurrence rate for primary BCC with high-risk features after Mohs surgery?

Answer 29

The long-term recurrence rate for primary BCC with high-risk features is 1-4% after Mohs surgery.

Question 30

How does the recurrence rate of Mohs surgery compare to standard excision for BCC?

Answer 30

Mohs surgery results in a recurrence rate that is 3-4-fold lower than standard excision for both primary and recurrent BCC.

Question 31

What factors are associated with a more than twofold reduction in recurrence rate after Mohs for BCC?

Answer 31

Factors associated with a more than twofold reduction in recurrence rate after Mohs include: - 1-cm diameter - Location on H zone - Infiltrative or micronodular histologic pattern.

Question 32

What is the recurrence rate for primary squamous cell carcinoma (SCC) after standard excision and after Mohs surgery?

Answer 32

- Primary SCC: Up to 8.1% after standard excision and 3.1% after Mohs surgery.

Question 33

What are the four factors strongly associated with adverse outcomes in SCC?

Answer 33

The four factors associated with adverse outcomes in SCC are: 1. Diameter greater than 2 cm 2. Depth of invasion below subcutaneous adipose 3. Perineural invasion 4. Poor histologic differentiation.

Question 34

How does the presence of risk factors affect local recurrence rates in SCC?

Answer 34

The presence of risk factors increases local recurrence rates: - 0.6% with no risk factors - 5% with 1 risk factor - 21% with 2-3 risk factors.

Question 35

What is the significance of perineural invasion in SCC cases?

Answer 35

SCC with perineural invasion was found to metastasize in 47% of cases after standard excision compared with 8.3% of cases after Mohs surgery.

Question 36

What are the implications of host immunosuppression in SCC treatment?

Answer 36

Host immunosuppression is a risk factor for adverse outcomes in SCC that may benefit from Mohs surgery, particularly in high-risk locations such as the lip, ear, temple, and penile skin.

Question 37

What is the differential efficacy of Mohs surgery compared to standard excision for SCC?

Answer 37

The differential efficacy of Mohs surgery over standard excision is most pronounced for: - Tumors in the H zone of the face - Tumors greater than 2 cm - Aggressive histologic features.

Question 38

What are the recommended treatments for SCC in situ and why?

Answer 38

For SCC in situ, other forms of treatment besides Mohs should be considered due to minimal depth of invasion.

Question 39

What is the most common technique used for melanoma detection during Mohs surgery?

Answer 39

The most common technique is Mohs using immunohistochemical stains for melanoma antigen recognized by T cells (MART-1) on rapidly processed frozen sections.

Question 40

What are the limitations of using MART-1 in melanoma detection?

Answer 40

Its use is limited to melanoma in situ and superficially invasive melanoma (Breslow depth <1mm) with minimal risk of metastasis.

Question 41

What alternative methods have been proposed for melanoma treatment besides Mohs?

Answer 41

Other investigators have proposed staged excision with formalin-fixed sections or a combination of perpendicular (bread-loaf) and en face frozen sections during Mohs, both achieving high cure rates of >95%.

Question 42

What is the recurrence rate of dermatofibrosarcoma protuberans (DFSP) after conventional excision compared to Mohs?

Answer 42

Local recurrence after conventional excision was 6% compared to 1% for Mohs.

Question 43

What types of tumors are likely to benefit most from Mohs surgery?

Answer 43

Mohs is likely to provide the most therapeutic benefit for tumors with broad and unpredictable subclinical extension, such as microcystic adnexal carcinoma or tumors in critical anatomic locations like sebaceous carcinoma of the eyelid.

Question 44

What are the healing characteristics of defects resulting from Mohs surgery?

Answer 44

Defects resulting from Mohs may be suited to healing without reconstruction because it often creates wounds of shallow depth that may be conducive to second intent healing.

Question 45

What technique is most commonly used for melanoma in situ during Mohs surgery?

Answer 45

Mohs surgery using immunohistochemical stains for melanoma antigen recognized by T cells (MART-1) on rapidly processed frozen sections is most commonly used.

Question 46

Why might staged excision be beneficial for superficial melanoma on chronically sun-exposed skin?

Answer 46

Staged excision is beneficial because nearly 20% of superficial melanomas on chronically sun-exposed skin have subclinical extension beyond the recommended 5-mm margin of grossly uninvolved skin.

Question 47

What are the considerations for treating SCC in situ, and why might Mohs surgery not be the preferred option?

Answer 47

For SCC in situ, other forms of treatment besides Mohs should be considered due to the minimal depth of invasion.

Question 48

What complications arise from using frozen sections in the detection of melanoma?

Answer 48

Artifacts introduced on frozen sections complicate the detection of intraepidermal melanocytes and decrease the sensitivity of melanoma detection.

Question 49

What is the most common technique used in Mohs surgery for melanoma, and what are its limitations?

Answer 49

The most common technique is Mohs using immunohistochemical stains for melanoma antigen recognized by T cells (MART-1) on rapidly processed frozen sections, limited to melanoma in situ and superficially invasive melanoma (Breslow depth <1mm) with minimal risk of metastasis.

Question 50

What alternative methods have been proposed for excising melanoma, and what are their success rates?

Answer 50

Staged excision with formalin-fixed sections or a combination of perpendicular (bread-loaf) and en face frozen sections during Mohs can achieve high cure rates of >95%.

Question 51

Why might staged excision be beneficial for patients with superficial melanoma on chronically sun-exposed skin?

Answer 51

Nearly 20% of patients with superficial melanoma on chronically sun-exposed skin may have subclinical extension beyond the recommended 5-mm margin of grossly uninvolved skin, making staged excision beneficial.

Question 52

What is dermatofibrosarcoma protuberans (DFSP), and how does it behave in terms of metastasis and recurrence?

Answer 52

Dermatofibrosarcoma protuberans is a slowly progressive tumor that rarely metastasizes but has broad subclinical extension and a high recurrence rate after conventional excision.

Question 53

What are the local recurrence rates for DFSP after conventional excision compared to Mohs surgery?

Answer 53

Local recurrence after conventional excision was 6% compared to 1% for Mohs surgery.

Question 54

What criteria determine the suitability of Mohs surgery for solid cancers?

Answer 54

Any solid cancer with contiguous growth that can be identified on frozen histopathologic sections and is accessible from the external surface of the body can be treated with Mohs.

Question 55

In what scenarios is Mohs surgery likely to provide the most therapeutic benefit?

Answer 55

Mohs is likely to provide the most therapeutic benefit for tumors with broad and unpredictable subclinical extension, such as microcystic adnexal carcinoma, or tumors in critical anatomic locations like sebaceous carcinoma of the eyelid or EMPD.

Question 56

What types of tumors have been treated with Mohs surgery?

Answer 56

Mohs has been used for treatment of adnexal carcinoma, apocrine and eccrine carcinoma, leiomyosarcoma, Merkel cell carcinoma, and mucinous carcinoma.

Question 57

What are the healing characteristics of defects resulting from Mohs surgery?

Answer 57

Defects resulting from Mohs may be suited to healing without reconstruction because they often create wounds of shallow depth that may be conducive to second intent healing.

Question 58

What are the advantages of using second intent healing in Mohs surgery for certain wounds?

Answer 58

Second intent healing in Mohs surgery can lead to reliable functional and cosmetic results, particularly for wounds on thin skin areas like the eyelid or ear, and concave surfaces such as the medial canthus and anterior surface of the ear. In appropriately selected patients, this method results in patient satisfaction equivalent to primary surgical repair.

Question 59

What are the most common adverse events associated with Mohs surgery?

Answer 59

The most common adverse events associated with Mohs surgery include: 1. Infections (0.40%) 2. Impaired wound healing including dehiscence and necrosis (0.14%) 3. Postoperative bleeding or hematoma (0.11%)

Question 60

What is the overall adverse event rate for Mohs surgery?

Answer 60

The overall adverse event rate for Mohs surgery is 0.72%, with a serious adverse event rate of 0.02%.

Question 61

What considerations should be made for patients on anticoagulants undergoing Mohs surgery?

Answer 61

Patients on anticoagulants such as aspirin, warfarin, or direct factor Xa inhibitors have a modestly increased risk of minor bleeding complications; however, this is not a contraindication to Mohs surgery. Patients are advised to continue their prescribed anti-coagulation therapy during and after surgery.

Question 62

When is antibiotic prophylaxis recommended before Mohs surgery?

Answer 62

Antibiotic prophylaxis before Mohs surgery is generally not required, except for patients at high risk of complications from infective endocarditis (e.g., those with prosthetic heart valves or significant congenital heart disease) and in cases of breach of the oral mucosa or for patients with total knee or hip replacements at increased risk of hematogenous total joint infection.

Question 63

A patient with a history of cardiac transplant and significant valvular disease is undergoing Mohs surgery. Should antibiotic prophylaxis be considered?

Answer 63

Yes, antibiotic prophylaxis is recommended for patients at high risk of complications of infective endocarditis, such as those with significant valvular disease.

Question 64

A patient with a history of total knee replacement is undergoing Mohs surgery. Should antibiotic prophylaxis be considered?

Answer 64

Yes, antibiotic prophylaxis is recommended for patients with total knee or hip replacement who are at increased risk of hematogenous total joint infection.

Question 65

A patient with a history of infective endocarditis is undergoing Mohs surgery. Should antibiotic prophylaxis be considered?

Answer 65

Yes, antibiotic prophylaxis is recommended for patients with a history of infective endocarditis.

Question 66

What are the advantages of using second intent healing in Mohs surgery for certain patients?

Answer 66

In appropriately selected patients, healing of Mohs surgical defects by second intent results in patient satisfaction that is equivalent to primary surgical repair. This method is particularly effective for wounds on thin skin areas such as the eyelid or ear, and on concave surfaces like the medial canthus and anterior surface of the ear.

Question 67

What are some common adverse events associated with Mohs surgery, and what are their rates?

Answer 67

The most common adverse events in Mohs surgery include: 1. Infections: 0.40% 2. Impaired wound healing (including dehiscence and necrosis): 0.14% 3. Postoperative bleeding or hematoma: 0.11% Overall, the adverse event rate is 0.72% and the serious adverse event rate is 0.02%.

Question 68

How does the use of local anesthetic contribute to the safety of Mohs surgery?

Answer 68

The use of local anesthetic, along with the lack of significant volume shift or cardiovascular stress after cutaneous surgery, likely contributes to the overall safety of Mohs surgery.

Question 69

What is the recommendation for patients on anticoagulants undergoing Mohs surgery?

Answer 69

Patients on anticoagulants such as aspirin, warfarin, or direct factor Xa inhibitors are advised to continue their prescribed anti-coagulation therapy during and after Mohs surgery, as having these medications is not a contraindication to the procedure, although they may have a modestly increased risk of minor bleeding complications.

Question 70

In what situations is antibiotic prophylaxis recommended before Mohs surgery?

Answer 70

Antibiotic prophylaxis is generally not required before Mohs surgery, except in specific cases such as: 1. Patients at high risk of complications of infective endocarditis (e.g., those with prosthetic heart valves, prior history of infective endocarditis, or significant congenital heart disease). 2. Breach of the oral mucosa. 3. Patients with total knee or hip replacement who are at increased risk of hematogenous total joint infection.

Question 71

What surgical techniques have been popularized by Mohs surgeons for cutaneous reconstruction?

Answer 71

Mohs surgeons have popularized several advances in cutaneous reconstruction, including: 1. Buried vertical mattress suture 2. Modern bilobe transposition skin flap on the nose 3. Use of cartilage grafts 4. Multistaged interpolation flaps

Question 72

What is the overall adverse event rate for Mohs surgery, and how does it compare to serious adverse events?

Answer 72

The overall adverse event rate for Mohs surgery is 0.72%, while the serious adverse event rate is significantly lower at 0.02%. This indicates that Mohs surgery is a remarkably safe procedure with low complication rates.

Question 73

What factors contribute to patient satisfaction in Mohs surgery when using second intent healing?

Answer 73

Factors contributing to patient satisfaction in Mohs surgery using second intent healing include reliable functional and cosmetic results, particularly in appropriately selected patients, and the ability to achieve outcomes equivalent to primary surgical repair.

Question 74

What are the implications of using immediate surgical repair techniques in Mohs surgery?

Answer 74

Immediate surgical repair techniques, such as linear closure, skin grafts, or skin flaps from adjacent or interpolated tissue reservoirs, are now used more often than second intent healing.

Question 75

What is the significance of the low complication rates associated with Mohs surgery?

Answer 75

The low complication rates associated with Mohs surgery, with an overall adverse event rate of 0.72% and serious adverse event rate of 0.02%, signify that it is a remarkably safe procedure, making it a preferred option for skin cancer treatment.

Question 76

How do Mohs surgeons approach the use of antibiotic prophylaxis in their practice?

Answer 76

Mohs surgeons generally use antibiotic prophylaxis sparingly and only in patients who meet specific criteria, such as those at high risk for infective endocarditis or those with certain surgical conditions.

Question 77

What are the overall cost benefits of Mohs surgery compared to standard excision?

Answer 77

Overall costs of Mohs surgery may be 20-30% less than standard excision.

Question 78

What organizations published the Appropriate Use Criteria for Mohs surgery?

Answer 78

The Appropriate Use Criteria for Mohs surgery were published by the AAD, American College of Mohs Surgery, American Society for Dermatologic Surgery, and American Society for Mohs Surgery.

Question 79

What factors are defined in the Appropriate Use Criteria for Mohs surgery?

Answer 79

The Appropriate Use Criteria define tumor-specific and patient-specific factors for which Mohs surgery is deemed to be either appropriate, uncertain, or inappropriate.

Question 80

What is the significance of the risk area in determining the appropriateness of Mohs surgery?

Answer 80

The risk area is crucial in determining the appropriateness of Mohs surgery, as it categorizes the diagnosis into high, medium, or low risk.

Question 81

How does the clinical diameter of a tumor affect the use of Mohs surgery according to the criteria?

Answer 81

The clinical diameter of a tumor influences the appropriateness of Mohs surgery, with different risk areas and tumor types being scored as appropriate (A) or inappropriate (U) based on size categories: <0.5 cm, 0.6-1 cm, 1.1-2 cm, and >2 cm.

Question 82

What are the implications of high-risk features for squamous cell carcinoma (SCC) in Mohs surgery?

Answer 82

High-risk features for SCC, such as perineural invasion or infiltrative features, indicate a need for careful consideration in the use of Mohs surgery.

Question 83

What is the role of patient-specific factors in the decision-making process for Mohs surgery?

Answer 83

Patient-specific factors play a significant role in the decision-making process for Mohs surgery, as they help determine whether the procedure is appropriate, uncertain, or inappropriate.

Question 84

What types of basal cell carcinoma (BCC) are considered in the Mohs surgery criteria?

Answer 84

The Mohs surgery criteria consider various types of BCC, including primary nodular BCC, primary aggressive BCC, primary superficial BCC, and recurrent BCC (both superficial and not superficial).

Question 85

What is the importance of defining high-risk areas in the context of Mohs surgery?

Answer 85

Defining high-risk areas is important in Mohs surgery as it helps identify regions where tumors are more likely to recur or have aggressive behavior.

Question 86

How does the classification of tumors by clinical diameter impact the treatment approach in Mohs surgery?

Answer 86

The classification of tumors by clinical diameter impacts the treatment approach in Mohs surgery by determining the risk area and guiding whether the surgery is deemed appropriate or inappropriate.

Question 87

What type of excision is used in Mohs Micrographic Surgery?

Answer 87

Tangential or beveled excision.

Question 88

What are the high-risk areas for Mohs surgery according to the AUC?

Answer 88

High-risk areas include the H zone of the face: eyelids, eyebrows, nose, lips, chin, ears, periauricular skin, and temples, as well as genitalia, hands, feet, ankles, nipple, and areola region.

Question 89

What is the appropriate surgical margin for nodular BCC?

Answer 89

4 mm for nodular BCC.

Question 90

Give 2 risk factors that predict microscopic tumor extension of BCC.

Answer 90

1. Poorly defined clinical margins 2. Diameter greater than 2cm.

Question 91

Give 2 factors that appear strongly associated with adverse outcomes of SCC.

Answer 91

1. Diameter greater than 2cm 2. Depth of invasion below subcutaneous adipose.

Question 92

What are the medium-risk areas included in the Appropriate Use Criteria?

Answer 92

Medium-risk areas include cheeks, forehead, jawline, scalp, neck, and pretibial surfaces.

Question 93

T or F. Skin cancers requiring 5 stages is common.

Answer 93

False. Skin cancers requiring 4-6 stages is uncommon.

Question 94

T or F. Impaired wound healing is the most common adverse event of MMS.

Answer 94

False. Infections are the most common adverse events.

Question 95

A patient with a 1.5 cm basal cell carcinoma (BCC) on the forehead is being evaluated for Mohs surgery. Is this location considered high, medium, or low risk?

Answer 95

The forehead is considered a medium-risk area according to the Appropriate Use Criteria.

Question 96

A patient with a basal cell carcinoma (BCC) on the chin is undergoing Mohs surgery. What are the high-risk areas for BCC according to the Appropriate Use Criteria?

Answer 96

High-risk areas include the H zone of the face (eyelids, eyebrows, nose, lips, chin, ears, periauricular skin, temples), genitalia, hands, feet, ankles, nipple, and areola region.

Question 97

A patient with a basal cell carcinoma (BCC) on the trunk is being evaluated for Mohs surgery. Is this location considered high, medium, or low risk?

Answer 97

The trunk is considered a low-risk area according to the Appropriate Use Criteria.

Question 98

A patient with a basal cell carcinoma (BCC) on the scalp is undergoing Mohs surgery. Is the scalp considered a high, medium, or low-risk area?

Answer 98

The scalp is considered a medium-risk area according to the Appropriate Use Criteria.

Question 99

A patient with a basal cell carcinoma (BCC) on the jawline is undergoing Mohs surgery. Is the jawline considered a high, medium, or low-risk area?

Answer 99

The jawline is considered a medium-risk area according to the Appropriate Use Criteria.

Question 100

Is it true or false that skin cancers requiring 5 stages is common?

Answer 100

False. Skin cancers requiring 4-6 stages is uncommon.

Question 101

What are 2 risk factors that predict microscopic tumor extension of BCC?

Answer 101

1. Poorly defined clinical margins 2. Diameter greater than 2cm.

Question 102

What are 2 factors that appear strongly associated with adverse outcomes of SCC?

Answer 102

1. Diameter greater than 2cm 2. Depth of invasion below subcutaneous adipose.

Question 103

Is it true or false that impaired wound healing is the most common adverse event of MMS?

Answer 103

False. Infections are the most common adverse events.

Question 104

Give 1 example of patients that may need antibiotic prophylaxis for Mohs.

Answer 104

Patients with a history of prosthetic heart valves or those undergoing Mohs surgery in high-risk areas may need antibiotic prophylaxis.

Question 105

What are the medium risk areas included in the Appropriate Use Criteria?

Answer 105

Medium-risk areas include: - Cheeks - Forehead - Jawline - Scalp - Neck - Pretibial surfaces.

Question 106

Who are considered patients at high risk of infective endocarditis?

Answer 106

Patients at high risk include those with total knee or hip replacements.

Question 107

What are the characteristics of patients at high risk for infective endocarditis?

Answer 107

Patients at high risk for infective endocarditis include those with total knee or hip replacements.

Question 108

Which areas of the body are considered medium risk for surgical procedures?

Answer 108

Medium risk areas include the cheeks, forehead, jawline, scalp, neck, and pretibial surfaces.