Mohs surgery: commentaries and controversies.

There is an enormous amount of literature pertaining to the subject of Mohs surgery, ranging from its various indications to therapeutic results. One constant limiting factor in this body of knowledge, however, is the scarcity of randomized, controlled studies comparing Mohs surgery with other effective therapeutic modalities. Obviously, it is hard to gather solid scientific evidence in favor or against this technique without comprehensive controlled studies, but evidence in its favor abounds in the form of the personal experience of practitioners, several excellent comparative retrospective evaluations, and the outcomes of thousands of patients treated over the years. In our opinion, there is sufficient evidence to support the use of Mohs surgery for treatment of selected skin cancers, and yet the medical community in general and dermatologists in particular are divided in their opinions concerning this therapeutic modality. As a matter of fact, Mohs surgery is frankly controversial among many of our colleagues, both in the academic and private sectors. It is not rare for a Mohs surgeon to be constantly antagonized by other specialists in different forums including tumor boards or scientific presentations, always with the complaint of using Mohs surgery without solid evidence of its effectiveness. Herein, we present our views on the available literature on Mohs micrographic surgery as regards its indications, advantages, disadvantages, and therapeutic results. Also, we explore the reasons for controversy and present some of our therapeutic failures to reflect on the nature and limitations of this fascinating technique. Indications for Mohs Surgery