Re: MOHS, respect please!

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Gayle Callis is, of course, entirely right about Mohs surgery as properly 
performed. My sister had one of these procedures to control a fairly 
aggressive basal cell carcinoma on a lower eyelid near the gray border, with 
no recurrence after a couple of years, an almost invisible scar, and no 
functional deficit.

Mohs surgery requires meticulous co-operation between the surgeon and the 
people preparing the sections. Many Mohs surgeons read their own frozen 
section slides, and I think it's better that they do so - if only because 
they can get paid much for doing it than a pathologist can. As I understand 
it, usually a Mohs surgeon has two patients going at once, and works on one 
of them while waiting for sections from the other one.

The pathologist's problems arise when surgeons (more often pseudosurgeons) 
expect this service with no warning to the pathologist, who then has to take 
a whole afternoon preparing sections without so much as a clerk to assist 
him, often with a 30 year old cryostat with a dull blade. At times like this 
tempers often get short, and pathologists often get fired - we're easy to 
replace, after all. Many such surgeons aren't actually doing Mohs surgery at 
all, just ordinary wide excisions, with the demands on the pathologist being 
made so they can bill for the Mohs procedure.

I wish these things weren't a commonplace, but in my travels they are. Mohs 
surgery is all right with proper support and adequate resources. It's a 
disaster without them.

Bob Richmond
Samurai Pathologist
Knoxville TN

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