This case involves a middle-aged man who underwent a Mohs procedure in order to remove a cancerous lesion from the skin of his face. The lesion was removed from underneath his left eye on the ridge of his cheekbone, and the procedure began with a conservative approach initially. However, as the procedure progressed the margins were steadily increased, until a substantial section of skin was removed. The patient was left with a conspicuous deformity as a result, and it was later claimed that the removal of tissue was too aggressive for his diagnosis.
Question(s) For Expert Witness
- 1. How often do you perform Mohs skin cancer surgery?
- 2. What can be avoided to remove unnecessary layers of skin during the surgery?
Expert Witness Response E-028773
My clinical practice only involves Mohs surgery and skin cancer care. I perform Mohs 2 times a week and see patients otherwise for only skin cancer issues. My clinical expertise is in high-risk skin cancer. Previously I served as the Director of Dermatologic Surgery at a major university where I directed the High Risk Skin Cancer clinic. I currently run the High Risk Skin Cancer Clinic at a major west-coast medical center. My research and clinical interest are in aggressive skin cancers. Proper surgical technique and review of histology is the best way to prevent unnecessary layer removal. Evaluating a lesion and the initial biopsies are critical to planning the surgery. During surgery, review of histology is critical and making sure that proper processing provides high-quality slides during each stage so unnecessary stages are not needed and further layers taken. I have reviewed multiple cases where margins were inappropriately called clear.