A Surgeon’s Map: The Power and Precision of Mohs Surgery

At Dermatology Week 2025, Howard Steinman, MD, delivered a concise yet compelling session titled “Comprehensive Overview of Mohs Surgery: Techniques and Indications.” Blending surgical fundamentals with real-world insights, Dr Steinman broke down what makes Mohs surgery uniquely powerful and why recognizing its indications can mean the difference between recurrence and cure.

With over 3 decades of experience, Dr Steinman brought both authority and practicality to the conversation. “Whether you’re a referring physician, a provider, or just someone curious about Mohs,” he said, “there are key principles everyone should understand.”

Dr Steinman opened with a brief historical nod to Frederic Mohs and how the technique evolved from a 2-day fixed-tissue protocol to today’s in-office fresh tissue method. This modern approach allows for same-day tumor removal and reconstruction—something Dr Steinman emphasized as both efficient and patient-friendly.

What sets Mohs apart? “It’s the only type of surgery where you’re looking at the entire surgical margin in 1 contiguous piece,” he explained, highlighting its unparalleled precision. That ability to examine 100% of the margins—rather than just sample sections—translates to lower recurrence rates and smaller defects, particularly valuable on the face, ears, and other cosmetically sensitive sites.

A standout moment came when Dr Steinman introduced the Mohs map—a simple hand-drawn diagram that he called “your best pathology report.” This map not only guides the surgical stages but also serves as a critical visual record of what was found and where, even years later.

The talk then turned to real-world indications. Dr Steinman outlined when to consider Mohs: recurrent tumors, high-risk locations like the central face, aggressive histologic subtypes, perineural invasion, and immunocompromised patients, to name a few. He encouraged attendees to use the widely available Appropriate Use Criteria app when deciding whether to refer.

But perhaps his most practical advice came down to the basics: Send the pathology report and mark the biopsy site. “Have the patient take a photo on their phone,” he advised. “You’d be surprised how often we don’t know where the tumor was.”

Dr Steinman concluded with a forward-looking glimpse at rapid immunohistochemistry staining, now making it possible to treat select melanomas in-office. “This has revolutionized what Mohs surgeons can accomplish,” he said, signaling exciting shifts in how complex tumors are managed without the operating room.

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Reference

Steinman HK. Comprehensive overview of Mohs surgery: techniques and indications. Presented at: Dermatology Week; May 14–16, October 22–25, 2025; Virtual.