The State of Mohs Micrographic Surgery in 2025-2026: Current Challenges, Pressures, and the Path Forward.

Albert E Zhou, Christian Gronbeck, Jenny J Kim, Siegrid Yu, Hao Feng, Daniel M Klufas

Abstract readReview

In one paragraph

Review in The Journal of clinical and aesthetic dermatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it

0cells of the map it votes in

0citing papers in PubMed

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Albert E ZhouDrs. Zhou and Kim are with the Department of Dermatology, University of California Los Angeles, Los Angeles, California.

Christian GronbeckDr. Gronbeck is with Zitelli, Brodland, and Lim Skin Cancer Center, Pittsburgh, Pennsylvania.

Jenny J KimDrs. Zhou and Kim are with the Department of Dermatology, University of California Los Angeles, Los Angeles, California.

Siegrid YuDr. Yu is with the Department of Dermatology, University of California San Francisco, San Francisco, California.

Hao FengDrs. Feng and Klufas are with the Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut.

Daniel M KlufasDrs. Feng and Klufas are with the Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMohs micrographic surgery (MMS) unites staged extirpation, comprehensive intraoperative histopathologic assessment, and immediate reconstruction to deliver durable local control with tissue conservation in anatomically critical sites. Contemporary practice, however, is shaped by intersecting forces: stewardship of indications, reimbursement trends, vertical consolidation, expanding use of intraoperative immunohistochemistry (IHC), and the emergence of complementary modalities (superficial radiation therapy; hedgehog and programmed cell death-1 [PD-1] inhibitors) alongside digital tools (teledermatology, artificial intelligence [AI], optical coherence tomography [OCT], reflectance confocal microscopy [RCM]).

objectiveTo provide a narrative synthesis that clarifies where MMS adds the greatest value, delineates the appropriate roles of competing and complementary treatments, and outlines pragmatic steps (clinical, economic, and educational) to preserve high-quality, margin-controlled cutaneous oncology.

methodsWe conducted a structured narrative review of MEDLINE and Embase (January 2000-December 2025) using controlled vocabulary and keywords for MMS; basal cell and cutaneous squamous cell carcinoma; melanoma in situ; radiation therapy; systemic therapy (hedgehog/PD-1); IHC; teledermatology/AI; and optical imaging (OCT/RCM). Eligible studies included randomized trials, prospective cohorts, comparative observational studies, systematic reviews/meta-analyses, and cost or reimbursement analyses reporting local control/recurrence, complications, episode-level cost, or implementation outcomes.

conclusionMMS provides superior or noninferior oncologic control with tissue preservation, same-day repair, and favorable safety in ambulatory settings. Appropriate use criteria should be framed as clinical stewardship, while superficial radiation and systemic therapies are best positioned as complements to MMS when surgery is infeasible or as neoadjuvant/adjuvant strategies. Sustaining the value of MMS will require explicit documentation of surgeon work and practice expense, standardized outcomes and patient-reported measures, equitable workforce strategies, and measured adoption of validated technologies such as OCT/RCM and AI. Payers and policymakers should recognize and preserve the true clinical and economic contribution of MMS.

Indexed as

appropriate use criteriaartificial intelligencebasal cell carcinomacost-effectivenesscutaneous squamous cell carcinomaimmunohistochemistryMohs micrographic surgeryreimbursementsuperficial radiation therapyteledermatology

Identifiers

PMID42877396

PMCPMC13668094

What OpenQuestion holds

Textmetadata

Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.