Abstract

Mohs micrographic surgery (MMS), although gold standard for removal of cutaneous tumors, may confer increased risk because of the time between excision, staging, and closure. To decrease these risks, we have utilized a technique called “rim and deep margin”, previously described in John et al. Here we present additional MMS cases using the previously described technique to minimize bleeding and operative time for patients with increased risk of morbidity, such as those with large tumor size or on anticoagulation medication. We present further utility of this technique, for use in those whose surgery had been delayed due to the COVID-19 pandemic. Delayed care for skin cancers is significantly associated with increased tumor size in SCCs. Increased tumor size (>2-6 cm) is associated with increased risk of metastasis (SCC) or increased risk of recurrence (BCC). A delay of >1 year was associated with doubling in defect size in BCC. Additionally, patients greater than 65 years of age are more likely to have a delay in treatment, even before pandemic. Finally, this technique may aid in reducing intraoperative time for larger tumors removed in fewer stages. Herein, we describe six cases in patients with various indications for use of this technique – for example, large tumor size, anticoagulation, and in one case, a patient who was quadriplegic and unable to lay flat for surgery. Successful implementation of this technique may lead to decreased intraoperative or postoperative complications, especially for high-risk patients or those with large lesions.

FInancial Disclosure:
The poster abstract presenter listed below disclosed the following information about their financial interests. The ASDP Ethics Committee has reviewed these disclosures and determined that no conflicts of interest exist between financial relationships and educational content being presented.

Speaker	Company	Affilition/Relationship
Babar Rao, MD	Caliber Imaging & Diagnostics	Consultant