Slow Mohs' technique

“Slow Mohs” is a very useful technique for histologically subtle neoplasms that may be difficult to recognize on frozen sections that are used in the regular Mohs procedure. Examples include lentigo maligna, sebaceous carcinoma with intraepidermal pagetoid spread, extramammary Paget's disease, dermatofibrosarcoma protuberans and acrolentiginous melanoma in situ. Slow Mohs represents a staged excision but in contrast to Mohs micrographic surgery, the margins are processed as rush permanent sections. We have successfully employed this technique for several years. This is a technically complex procedure and its success depends on collaboration and precise communication between surgeon and pathologist.

We have had the best results with the following technique:

1. alert our laboratory that you are planning a slow Mohs procedure
2. it is paramount that we can evaluate the original neoplasm. If the original biopsy was not reviewed by us, this can be archieved by submitting the debulking specimen, provided it contains tumor or by including the original biopsy slide with the Mohs margins.