I have frequent tiny BCCs. I am confused about the difference between a standard biopsy and a Mohs biopsy. I want to have all done at one time: a biopsy and then Mohs surgery if BCC is detected. In the section entitled "Do you have to have a biopsy before Mohs surgery" one doctor said: "The biopsy could be a frozen biopsy and if the results prove there to be a skin cancer, then the Mohs surgery could be done." He does not state if there are any negatives associated with this immediate approach.
Can Mohs Surgery Be Done Immediately After a Frozen Biopsy on a Tiny Bump Under Lip if BCC is Diagnosed?
Doctor Answers 4
Mohs Surgery After Frozen Biopsy #mohssurgery
I do many Mohs reconstructions a year for my referring Dermatologists. There are many ways to approach this. Most patients that I see have already had a diagnosis of their skin cancer from a biopsy. They then will see their Mohs surgeon to have the lesion completely removed and I then perform the reconstruction the same day. Mohs surgery is a great procedure for skin cancer of the head and neck region. It allows the Mohs surgeon to get rid of the cancer while preserving tissue for reconstruction. So yes, you can have the biopsy followed by Mohs but that is not typically how I see this happen. The situation as I describe above is how I most commonly see these cancers being treated.
Yes, Mohs can be done after a frozen section biopsy.
Yes, a frozen section biopsy can be done prior to Mohs surgery. I tend to limit this practice to very few situations though. For example, if there is a suspicious lesion immediately adjacent to where I am working, I want to know what it is, as it could affect my closure.
The potential negatives include:
1. A frozen section biopsy does not provide the same cellular detail and can have artifact that a permanent section biopsy does not have.
2. There may be a bias that develops when reading a biopsy right before surgery...of course the incentive is to read this out as a BCC (when it may be something like a trichoepithelioma instead). If the biopsy is read by another dermatopathologist, this potential bias is eliminated.
3. Sometimes it is difficult to make a diagnosis and you may require immunohistochemistry studies or need a second opinion. Doing the frozen section biopsy right before Mohs makes it very difficult to do this.
4. What if your biopsy is negative right before Mohs? Then the doctor has blocked a large amount of time on his schedule for your potential Mohs surgery which is cancelled. This is not fair to other patients who are waiting for this procedure and creates a scheduling nightmare.
So there are many negatives with doing this approach of biopsies immediately before Mohs.
Frozen section and then proceeding to Mohs
It is always more prudent to wait for a final result. Frozen sections can be difficult to cut and get a confirmatory final answer on.
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Frozen biopsies and Mohs...your insurance is another BIG factor here
The other physicians posting are 100% right here. But here's the other issue: many insurances don't like when a frozen biopsy is done and then a Mohs immediately after. They want a biopsy sent out to an independent lab for verification. So even though to patients, it may seem easier for a frozen biopsy and then an immediate procedure, your insurance may simply not allow this, in which case you could be stuck with a bill in the thousands of dollars.