Does Mohs Surgeon Need Detailed Pathology Report for Best Results? (Photo)

The Mohs surgeon whom you see will rely on the pathology report to a) confirm the diagnosis - in this case BCC and b) add information such as type of Basal Cell Carcinoma (BCC) that may influence the outcome.

With regards to a) confirming the diagnosis.  In Seattle, as in other parts of the country, skin biopsies are read by both dermatologists and dermatopathologists.  To some degree it depends on the comfort/preference of the dermatologist.  Pathology is an important piece of training for dermatologists.  BCC in most cases is considered a fairly straightforward pathologic diagnosis and most dermatologists who read their own pathology would be comfortable with this diagnosis most of the time.  It is not impossible for there to be a diagnostic error (ie something other than BCC) but I'd guess relatively unlikely in the hands of a good dermatologist.  With regards to b), the subtype of BCC does influence both the decision to do Mohs and the anticipated extent of the surgery.  In cases where the lesion is in difficult anatomic location like the nasal ala, the subtype of BCC will not be as important as an indication.  In other words, on the nasal ala, the anatomic location alone is reason enough to consider Mohs surgery for tissue sparing.  Some subtypes of BCC, e.g. infiltrative, would be expected to need a more extensive resection but again, given the location, this doesn't necessarily change the management and the Mohs surgeon may not feel that information will change what he/she does.

If you prefer a further comment on the pathology, your options would be:

1) Ask the dermatologist who did and read the biopsy for more detail

2) Ask the dermatologist who did the biopsy or the Mohs surgeon who sees you to request that the biopsy specimen be reviewed by a dermatopathologist (who will issue a report).

3) Ask if the Mohs surgeon wishes to review the slides from the biopsy themselves prior to doing the procedure.

Given the location on the ala, I'd recommend considering a consultation with the Mohs surgeon prior to any surgery at which visit you can raise these questions.

Hope that helps.

While a detailed pathology report can be helpful, it's not necessary. I receive many Mohs referrals and some have detailed path reports, and some do not. During the Mohs procedure, the Mohs surgeon is going to see where the margins are and take additional tissue as needed, anyway. That's the purpose of Mohs - to take as little skin as possible but have clear margins. Your Mohs surgeon should be able to perform the procedure with or without a detailed intial path report.