Utility of Rush Paraffin‐Embedded Tangential Sections in the Management of Cutaneous Neoplasms

Background. Mohs micrographic surgery (MMS) modified by the use of tangential, formalin‐fixed, paraffin‐embedded histologic specimens is advantageous in treating selected skin neoplasms. Objective. To review the use of our experience with a modification of MMS to treat lentigo maligna melanoma (LMM), lentigo maligna (LM) and other melanoma in situ (MIS) lesions, dermatofibrosarcoma protuberans (DFSP), atypical fibroxanthoma (AFX), and angiosarcoma. Methods. Our experience utilizing a modification of MMS in the treatment of 77 patients with LM or other MIS, 23 patients with LMM, 11 patients with DFSP, 1 patient with AFX, and 1 patient with angiosarcoma was reviewed. Length of follow‐up and rate of recurrence were examined. A literature review of this pertinent modification of the Mohs technique was performed. Results. One hundred fourteen patients underwent MMS for melanocytic (LM, MIS, LMM), spindle cell (DFSP, AFX), and vascular malignant neoplasms. One patient developed locally recurrent LM and one patient with LMM developed satellite metastasis. Regional lymph node metastasis occurred in one patient with LMM and in a patient with angiosarcoma. Conclusion. The use of Mohs micrographic surgery in conjunction with rush formalin‐fixed, paraffin‐embedded tangential histologic sections provides the accuracy and tissue conservation of the Mohs procedure while ensuring more confident interpretation of histology in cases of lentigo maligna, lentigo maligna melanoma, dermatofibrosarcoma protuberans, atypical fibroxanthoma, and angiosarcoma.