Histopathologic Concordance of Mohs Micrographic Surgery: A Systematic Review

Abstract

Mohs micrographic surgery is dependent upon accurate interpretation of frozen section slides to ensure complete tumor removal and high cure rates. The objective of this study was to determine an aggregate concordance of histologic frozen section interpretation between the Mohs surgeon and dermatopathologists as available in the literature. The study sought to assess the bias risk, applicability, and level of evidentiary support for studies of histologic accuracy between these two provider groups. A systematic literature review of three medical databases was conducted. The Quality Assessment of Diagnostic Accuracy Studies instrument was used to determine bias risk and applicability. The level of evidence was then determined by using the Center for Evidence-Based Medicine (CEBM) model. According to the literature, the concordance rate for frozen slide interpretation between fellowship-trained Mohs surgeons and dermatopathologists was 99.4% after reviewing 5,566 cases with CEBM Level 2 evidence. This study confirms a high level of correlation of histologic frozen section slide interpretation between fellowship-trained Mohs surgeons and dermatopathologists, which is supported by Level 2 evidence with low bias risk and low applicability concerns.