With modern frozen section techniques examining the edges of the specimen, the two techniques are very similar. They are both performed by fine physicians.
However, I prefer to have a board certified pathologist review all pathologic specimens rather than a dermatopathologist, a dermatoligist who has trained in Moh's surgery. There are enough borderline lesions that are difficult to interpret; I prefer to have a pathologist who lives and breathes pathology rather than a dermatologist who has also trained in the interpretation of pathology slides.
Having a reliable pathologist is critically important, in my opinion. I have personally seen a number of cases where a patient was "cleared" by various methods, yet they had considerable cancer still remaining. This is especially apparent at the Veteran's Hospital where patients have had considerable sun damage and often present with large or neglected cancers.
I also believe that there should a conduit in place for second opinions, or additional interpretations of difficult lesions. It is arrogant for any one doctor to think they can make a definitive diagnosis by visual inspection alone and not need further opinions on difficult pathologic specimens, especially if they require specialized stains, immunologic testing, etc. In some cases I have sent pathology specimens to a primary pathologist, our local medical center (UCLA), the Department Chief, and the AFIP (Armed Forces Institute of Pathology), and even specialized world experts such as Dr. Ackerman for melanoma diagnosis.
When a difficult lesion occurs, that is where experience and judgment come in. Do you proceed with the surgery? Do you do a temporary fix until the definitive pathology is ready, even if that takes weeks? Is your doctor prepared for all levels of reconstruction, for any surprises that may come up?
All issues worth considering.
