Mohs surgery

Mohs Surgery in Europe: Past, Present and Future Mohs micrographic surgery (MMS) has evolved from an innovative tissue-sparing technique developed by Frederic E. Mohs in the 1930s into the gold standard treatment for high-risk basal cell carcinoma and selected other skin cancers.

This presentation will provide a historical perspective on the development of MMS, beginning with the earliest descriptions of basal cell carcinoma, the evolution of skin cancer treatment over the centuries, and the pioneering work that led to the introduction of complete margin-controlled surgery.

The lecture will then explore the introduction and expansion of Mohs surgery in Europe. Particular attention will be given to the establishment of dedicated Mohs centres, the development of national training programmes, and the founding and growth of the European Society for Micrographic Surgery (ESMS), which has played a pivotal role in promoting education, quality standards, research, and collaboration across Europe.

The Dutch experience will be used as an example of how Mohs surgery evolved from a specialised technique into an integral component of dermatologic oncology practice. Current European practice patterns and the recommendations of the Dutch Society of Dermatology and Venereology (NVDV) will be reviewed, highlighting indications, outcomes, and contemporary standards of care. 

Finally, the presentation will look ahead to the future of Mohs surgery. Emerging diagnostic technologies such as digital dermoscopy, optical coherence tomography (OCT), and line-field confocal OCT are increasingly improving preoperative tumour delineation and patient selection. Intraoperative innovations may enable more accurate determination of surgical margins before the first incision, potentially reducing the number of stages required.
Advances in digital pathology, including confocal microscopy, whole-slide imaging, and artificial intelligence-assisted tumour recognition, have the potential to transform intraoperative margin assessment and further enhance efficiency and accuracy. 

By connecting the historical foundations of Mohs surgery with current practice and future technological innovations, this lecture aims to provide a comprehensive overview of how MMS has become one of the most successful examples of precision surgery in dermatologic oncology and where the field may be heading in the coming decades. Learning objectives 

After attending this session, participants will be able to: 

• Describe the historical development of basal cell carcinoma management and the origins of Mohs micrographic surgery
• Explain the role of the ESMS in the dissemination, standardisation, and advancement of micrographic surgery across Europe
• Understand the current indications and guideline-based use of Mohs surgery in Europe, including the Dutch model of care
• Evaluate emerging technologies – including digital dermoscopy, OCT, confocal imaging, digital pathology, and artificial intelligence – and their potential impact on the future Mohs workflow