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Mohs micrographic surgery is a technique used to excise skin tumors based on comprehensive surgical mapping, in which the surgeon removes the tumor, followed by a complete histological evaluation of the tumor's margins. The correlation of the presence of a tumor in histological examinations and its precise location on the surgical map result in a complete removal of the tumor with maximum normal tissue preservation. The present article seeks to provide general practitioners and healthcare specialists with guidelines regarding recommendations for Mohs micrographic surgery to treat skin tumors, based on the most reliable evidence available in medical literature on the subject. This bibliographic review of scientific articles in this line of research was conducted based on data collected from MEDLINE/PubMed. The search strategy used in this study was based on structured questions in the Patient, Intervention, Control, and Outcome (PICO) format. MeSH terms were used as descriptors. The indications of this technique are related to recurrence, histology, size, definition of tumor margins, and location of tumors. These guidelines attempt to establish the indications of Mohs surgery for different types of skin tumors.

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Abstract: Mohs micrographic surgery is a technique used to excise skin tumors based on comprehensive surgical mapping, in which the surgeon removes the tumor, followed by a complete histological evaluation of the tumor's margins. The correlation of the presence of a tumor in histological examinations and its precise location on the surgical map result in a complete removal of the tumor with maximum normal tissue preservation. The present article seeks to provide general practitioners and healthcare specialists with guidelines regarding recommendations for Mohs micrographic surgery to treat skin tumors, based on the most reliable evidence available in medical literature on the subject. This bibliographic review of scientific articles in this line of research was conducted based on data collected from MEDLINE/PubMed. The search strategy used in this study was based on structured questions in the Patient, Intervention, Control, and Outcome (PICO) format. MeSH terms were used as descriptors. The indications of this technique are related to recurrence, histology, size, definition of tumor margins, and location of tumors. These guidelines attempt to establish the indications of Mohs surgery for different types of skin tumors.

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Introdução: O carcinoma basocelular (CBC) pigmentado muitas vezes se assemelha ao melanoma cutâneo por apresentar pigmentação assimétrica e padrão de crescimento irregular. Nessas situações, são necessários métodos diagnósticos auxiliares como a dermatoscopia, a histopatologia e, mais recentemente, a Microscopia Confocal (RCM) in vivo. A RCM é um método não invasivo, em tempo real, que fornece imagens instantâneas e permite visualizar estruturas microanatômicas no plano paralelo à pele, diferentemente dos cortes histológicos convencionais. Sua interpretação baseia-se na morfologia celular e no reconhecimento de padrões, ainda em estudo, associados aos achados dermatoscópicos e histopatológicos. Objetivos: Descrever os achados celulares dos CBCs pigmentados observados no exame de RCM, estabelecer os padrões diagnósticos desta técnica para essas lesões e correlacionar tais achados com as características dermatoscópicas e histopatológicas. Material e métodos: Foram selecionadas 34 lesões sugestivas de CBC pigmentado. Os pacientes participantes foram recrutados no Núcleo de Câncer de Pele e Dermatologia do A.C.Camargo Cancer Center no período de junho de 2011 a julho de 2012. Todos os pacientes foram avaliados quanto ao sexo, idade, cor da pele e localização anatômica da lesão. Após a suspeita diagnóstica de CBC, realizou-se a dermatoscopia e a RCM da lesão e somente uma área contendo uma característica dermatoscópica de interesse foi selecionada para o estudo histopatológico em cortes perpendiculares e transversais. Para a descrição da RCM foram utilizados termos previamente estabelecidos no Consenso de Terminologia da Microscopia Confocal. A metodologia utilizada para realização dos cortes perpendiculares e transversais foi baseada no método de Headington. Resultados: As características dermatoscópicas como área em folha, área em raio de roda, grandes ninhos ovóides azul-acinzentados e múltiplos glóbulos azul-acinzentados correlacioaram-se na RCM às ilhas de células tumorais com células dendríticas de formato e tamanhos variados. As telangiectasias arboriformes da dermatoscopia se correlacinaram aos vasos ramificados horizontais e calibrosos da RCM. Conclusão: Foram definidos os padrões do CBC pigmentado na RCM in vivo. Também foi possível correlacionar os achados celulares encontrados nas RCM com as estruturas dermatoscópicas e histopatológicas..

Introduction: Pigmented Basal cell carcinoma (BCC) often resembles melanoma skin by presenting asymmetrical pigmentation and irregular growth pattern. In these situations, auxiliary diagnostic methods are needed such as dermoscopy, histopathology and, more recently, confocal microscopy in vivo (RCM). RCM is a non invasive method which provides real-time instant imagens and allows visualizing the microanatomic structures parallel to the skin, differently from conventional sections. Its interpretation is based on the morphology cell and on pattern identification associated with dermatoscopy and histopathology findings. Objetives: Describe BCC structure cells observed in RCM, establish diagnostic methods for each and match such findings with dermatoscopy and histopathology features. Material and Methods: We selected 34 lesions suggestive of pigmented BCC. Patients were recruted from the Skin Cancer Division of A.C.Camargo Cancer Center from June 2011 to July 2012. All patients were analised as for their sex, age, skin type and anatomical location of the lesion. After the diagnosis of BCC was held dermoscopy and RCM of the lesion and only an area containing a characteristic dermoscopic of interest was selected for histopathological study. For the RCM in vivo description we use the Confocal Microscopy Terminology established on Confocal Microscopy Terminology Consensus. For the histopathological study we used the Headington method. Results: The characteristics such as mapleleaf like area, spoke-wheels area, large blue-gray ovoid nests and multiple blue-gray globules correlated in the RCM to the islands of tumor cells with dendritic cells of different shapes and sizes. Arborizing telangiectasias are correlated with branched and horizontal vessels in RCM. Conclusion: The pigmented BCC were defined in confocal microscopy. It was also possible to correlate the cells findings in the confocal microscopy with dermatoscopic and histopathological structures.

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