FOR PHYSICIANS
Journal Club
Led by Dr. Ian Maher — a Professor, Director of Dermatology, and Mohs Fellowship Director at the University of Minnesota — the American College of Mohs Surgery's Virtual Journal Club meets each month to discuss the best new literature related to dermatologic surgery.
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May 2026
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Dr. Daniel Knabel, Dr. Marie Clark, Dr. Brandon Calley, and Dr. Rachel Tao (Medical College of Wisconsin) present the best dermatologic surgery relevant literature from the March Journals.
April 2026
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Dr. Alex Nguyen (Mayo Clinic), Dr. Keegan O'Hern (Mayo Clinic), and Dr. Addison Demer (Mayo Clinic) present the best dermatologic surgery relevant literature from the March Journals.
March 2026
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Dr. Nate Campbell, Dr. Madeline Hooper and Dr. Morgan Belina (Northwestern) present the best dermatologic surgery relevant literature from the March Journals.
February 2026
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Dr. Kyle Rismiller, Dr. Andrew Bevins, and Dr. Pushkar Aggrawal of University of Cincinnati present the best dermatologic surgery relevant literature from the February Journals.
January 2026
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Dr. Ian Maher, Dr. Tess Lukowiak, Dr. Chandler Rundle, and Dr. Colby Presley from the University of Minnesota present the best dermatologic surgery relevant literature from the January Journals.
December 2025
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Dr. Anna Poliner (Northwell Health) and Dr. Victoria Sharon (Northwell Health) present the best dermatologic surgery relevant literature from the December Journals.
November 2025
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Dr. Lindsey Voller, Dr. Katie Shahwan, and Dr. David Carr from the Ohio State University present the best dermatologic surgery relevant literature from the November Journals.
October 2025
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- Article 1 take home points:
- Effectiveness: Nicotinamide 500 mg twice daily associated with modest reduction in subsequent skin cancers (~14%) in high-risk veterans
- Timing is key: Early initiation after first skin cancer provides greatest benefit (~54%)
- Comparison to prior evidence: Supports prior RCTs; confirms timing is critical; limited effect in solid-organ transplant recipients aligns with earlier small studies
- Clinical implications: Safe, inexpensive, well-tolerated; can be used as an adjunct to sun protection and routine dermatologic surveillance
- Future directions: Studies needed in diverse populations and to define optimal timing and duration of supplementation
- Article 2 take home points:
- Litigation involving Mohs surgery is rare, despite millions of cases yearly
- Lawsuits mostly stem from communication and documentation errors, not surgical mistakes
- Non-Mohs dermatologists: delay in diagnosis most common
- Mohs surgeons: lack of informed consent (36%) and fraudulent billing (27%)
- Fellowship-trained: more informed consent cases; non-fellowship-trained: all billing cases
- Wrong-site surgery not a leading cause in this dataset
- Fellowship programs should stress consent, billing integrity, and coordination of care
- Article 3 take home points:
- MART-1 en-face margins can be interpreted with high reproducibility among highlight trained Mohs surgeons
- "Hard calls" cluster in biologically gray zones rather than reader-specific variance
- Study design reflects reproducibility, not truth or outcomes
- Article 4 take home points:
- MMS significantly reduces local recurrence risk compared with CE in MCC
- Less frequent aRT use in MMS group (36.1% vs. 63.5% in CE) yet no survival disadvantage
- MMS is an effective approach for localized MCC, particularly on the head/neck and other high-risk sites
- Comparable survival outcomes with reduced radiation use and potential functional and cosmetic benefits
Dr. Fatima Mirza (Brown University), Dr. Pavane Gorrepati (Brown University), and Dr. Tiffany Libby (Brown University) present the best dermatologic surgery relevant literature from the October Journals:
- Article 1: Nicotinamide for Skin Cancer Chemoprevention
- Article 2: State and Federal Malpractice Litigation of Medical Liability Claims Involving Mohs Surgery, 1988 to 2024
- Article 3: Interrater and Intrarater Reliability of Mohs Surgeons in the Assessment of MART-1 Frozen Section Margins for Melanoma
- Article 4: Mohs micrographic surgery of Merkel cell carcinoma lowers local recurrence risk and has similar metastasis and survival compared with conventional excision: A single-center retrospective cohort study
September 2025
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- Article 1 take home points:
- High concordance: Supports reliability of trained Mohs surgeons in margin assessment for MIS
- Stain preferences: Mohs surgeons benefit from IHC stains (especially SOX10), while dermatopathologists often rely on H&E.
- Technical challenges: SOX10 is more specific but time-consuming; MART-1 is faster but less specific in sun-damaged skin.
- Margins: 60% of cases required greater than or equal to 9 mm margins, suggesting standard 5-mm margins may be insufficient for head/neck MIS.
- Article 2 take home points:
- Key finding: 2-OCT and 5-PS provide similar cosmetic outcomes for trunk and extremity closures at 1 year.
- Clinical recommendation: Consider 2-OCT, especially for chest wounds or when minimizing track marks is desired
- Future directions: Larger studies, inclusion of patient-reported outcomes, and assessment of other anatomical sites recommended.
- Article 3 take home points:
- N/A
- Article 4 take home points:
- N/A
Dr. Caroline Garraway (Washington University in St. Louis), Dr. Eddie Pradonovic (Washington University in St. Louis), and Dr. Laurin Council (Washington University in St. Louis) present the best dermatologic surgery relevant literature from the September Journals:
- Article 1: Concordance Between a Mohs Micrographic Surgeon and Dermatopathologist on Margin Status for Melanoma In Situ and the Role of Immunohistochemical Stains
- Article 2: Comparison of 5-0 Polypropylene Suture and N-Butyl/2-Octyl Cyanoacrylate for Closure of Surgical Wounds on the Trunk and Extremities: A Split Scar Study
- Article 3: Early Takedown of Postauricular, Melolabial, and Paramedian Forehead Interpolation Flaps: A Retrospective Cohort Study
- Article 4: Postoperative Defect Size as a Criterion for Upstaging High-Risk Cutaneous Squamous Cell Carcinoma Treated With Mohs Micrographic Surgery
August 2025
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- Article 1 take home points:
- This study did not identify a decrease in lower extremity infection rates with single does pre-operative antibiotics
- The authors do not recommend routine prophylactic antibiotics for below the knee lower extremity MMS
- The overuse of prophylactic antibiotics may potentially lead to increased adverse effects, antibiotic resistance, and health care spending.
- Article 2 take home points:
- Sonidegib may have some sustained action
- This looked at its action in patients who discontinued with most common cause being AE
- Are AE predictive of better response a al EGFRi?
- Very small group, hard to draw too much from it
- Makes me stress a little less about time interval between HHi discontinuation and surgery
- Article 3 take home points:
- N/A
- Article 4 take home points:
- Posterior lamella is there for a reason
- Holds lid in place prevents retraction
- Granulation can lead to proud flesh = PG
- Dry eye symptoms vary based on climate
- This was done in coastal Alabama
- Lid retraction is a bigger deal in drier and colder climates
- Beware in the cold
- Upper lids are less forgiving than lower lids
- Posterior lamella is there for a reason
- Article 5 take home points:
- N/A
Dr. Ian Maher (University of Minnesota) and Dr. Tess Lukowiak (University of Minnesota) present the best dermatologic surgery relevant literature from the August Journals:
- Article 1: Retrospective Review of the Infection Rate of Lower Extremities Treated With Mohs Micrographic Surgery With and Without Prophylactic Antibiotics
- Article 2: Efficacy following discontinuation of sonidegib 200 mg daily treatment in patients with locally advanced basal cell carcinoma: Post hoc analysis of the 42-month BOLT study
- Article 3: Radiologic imaging aids management of high-risk cutaneous squamous cell carcinoma: A retrospective cohort study
- Article 4: Success of Myocutaneous Flaps Without Posterior Lamellar Reconstruction for Large Full-Thickness Eyelid Mohs Defects
- Article 5: Single-Stage Transposition Flap Reconstructions of Surgical Defects of the Concha Cavum, Incisura, Antitragus, Antihelix, and Lobule
July 2025
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- Article 1 take home points:
- N/A
- Article 2 take home points:
- N/A
- Article 3 take home points:
- N/A
- Article 4 take home points:
- Deroofing has low recurrence rate at 1-year, few postoperative side effects, and high patient satisfaction
- Deroofing significantly reduces pain associated with HS
- For larger deroofings the authors suggest staging deroofings or use of tumescent anesthesia
Dr. Ian Maher (University of Minnesota) and Dr. Tess Lukowiak (University of Minnesota) present the best dermatologic surgery relevant literature from the July Journals:
- Article 1: Impact of tranexamic acid on postoperative complications and bleeding in facial aesthetic surgery: A systematic review and meta-analysis
- Article 2: Tranexamic Acid in Mohs Micrographic Surgery: A Systematic Review
- Article 3: T-Shaped Wedge Resection of the Upper Eyelid: An Alternative to the Pentagonal Wedge
- Article 4: Surgical Deroofing in the Management of Hidradenitis Suppurativa Alone or as an Adjunct to Medical Therapies
June 2025
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- Article 1 take home points:
- Adjuvant cemplimab vs. placebo:
- Significantly longer disease-free survival: 87% vs. 64% at 24 months
- 68% lower risk of disease recurrence or death
- 80% lower risk of locoregional recurrence
- 65% lower risk of distant recurrence
- Adjuvant cemplimab vs. cemplimab monotherapy in the context of advanced or metastatic disease
- Consistent with known safety profile
- 9.8% discontinued cemiplimab due to AEs
- 1 death related to cemiplimab (myositis)
- Need future research to evaluate benefit regarding overall survival
- Need individualized decision-making regarding whether to treat a patient with high-risk cSCC with adjuvant therapy or wait until disease recurrence before initiating immunotherapy
- Adjuvant cemplimab vs. placebo:
- Article 2 take home points:
- Dermatologic surgery and MMS are safe procedures with low incidence of serious postop infections
- We should reevaluate our use of prophylactic antibiotics in low-risk procedures, to balance the need to prevent serious infections with the risk of antibiotic resistance and iatrogenic AEs
- Reserve PAT for patient with specific risk factors or undergoing high-risk surgeries
- Need to redefine these risks in future research
- Article 3 take home points:
- Unna boots have shown a healing bandage for sutured wounds
- If something other than pressure is important what is it? Sealed wound = no contamination?
- If pressure is important is 12 hours enough?
- Certainly demonstrates that compression isn't necessary in the general lower leg wound population
- Also, no harm found and may have other benefits
- Would be interesting to look at pain/surgical satisfaction/etc.
- Aggressive management of swelling may help with sutured wounds
- Unna boots have shown a healing bandage for sutured wounds
- Article 4 take home points:
- Using MART-1 doesn't lead to more layers
- Other studies show it improves sensitivity
Dr. Ian Maher (University of Minnesota) and Dr. Lydia Luu (University of Minnesota) present the best dermatologic surgery relevant literature from the June Journals:
- Article 1: Adjuvant Cemiplimab or Placebo in High-Risk Cutaneous Squamous-Cell Carcinoma
- Article 2: Bacteremia, Infective Endocarditis, and Prosthetic Joint Infection After Dermatologic Surgery: Findings From a Global, Retrospective Cohort Study
- Article 3: Assessing the Efficacy of Compression Therapy on Second Intention Wound Healing After Dermatologic Surgery: A Randomized, Controlled Trial
- Article 4: Mohs for Melanoma With and Without MART-1 Stains: A Comparison of Outcomes
May 2025
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- Article 1 take home points:
- NUM treated with MMS and MART-1 has low LR
- Precise MMS technique and anatomical knowledge is essential
- While MMS can spare bone amputation, it may need to be done for reconstruction especially if there is extension to volar surface or proximal distal joint
- Article 2 take home points:
- MMS superior to WLE for treatment of high-stage SCC and should be offered as first line
- MMS led to halving of 3-year cumulative incidence of recurrence, metastasis, and DSD
- Future research should continue to focus on exploring the role of adjuvant therapies and surveillance for recurrence in high-stage SCC
- Article 3 take home points:
- This study demonstrates excellent concordance between Mohs surgeon and dermatopathologist (95%, with the Mohs surgeon erring on the side of caution and taking an additional layer in the 2 cases in which there was discordance), serving as reassurance that with proper training, margin assessment by a surgeon performing MMS for MIS or LM using H&E and IHC is equivalent to dermatopathology assessment
- A combination of H&E and IHC stains (either MART-1 or SOX10) was the most useful for assessing margins of MIS for the Mohs surgeon
- Faster staining protocols and further studies at a larger scale are required to determine the technical standards of MMS for melanoma
- Article 4 take home points:
- PDS is associated with higher risk clinical features than AFX, including significantly higher incidence of PNI, preoperative area, and rate of recurrence
- Factors associated with increased risk of tumor recurrence or death: female gender, immunosuppression, PNI
- Patients with PDS have a much higher overall mortality rate of 60% compared with 26.5% in patients with AFX
- It is important to continue researching the pathophysiology of these malignancies to provide better treatment options
Dr. Igor Kapetanovic (University of Minnesota) and Dr. Lydia Luu (University of Minnesota) present the best dermatologic surgery relevant literature from the May Journals:
- Article 1: Nail unit melanoma treated with Mohs micrographic surgery: Technique, local recurrence rate, and surgical outcomes
- Article 2: Mohs Surgery vs Wide Local Excision in Primary High-Stage Cutaneous Squamous Cell Carcinoma
- Article 3: Concordance Between a Mohs Micrographic Surgeon and Dermatopathologist on Margin Status for Melanoma In Situ and the Role of Immunohistochemical Stains
- Article 4: Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma: A Retrospective Review and Survival Analysis at a Single Academic Institution
April 2025
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- Article 1 take home points:
- This study successfully trained a machine learning segmentation model to automatically highlight the location of BCC on MMS frozen section slides
- Model sensitivity was higher for BCC subtypes with fewer individual foci
- Model specificity was higher for subtypes with many individual foci
- Novel performance metrics that are not so heavily influenced by BCC subtype are needed
- Future studies need to train models that reach near 100% accuracy and are externally validated before they can be used in clinical settings
- Article 2 take home points:
- More twists -> stronger knots
- Optimal knot security at 3-5 twists
- BUT more twists -> bulkier knots, higher variability in knot strength
- Poliglecaprone 25 more reliable than polyglactin 910 across all sizes
- More twists -> stronger knots
- Article 3 take home points:
- WW can be an adequate option, cost sparing and averting complications without detriment to patient health
- A skilled physical examination capable of distinguishing healthy scar tissue from residual SCC is crucial for selection which WW may yield a very low risk of local recurrence
- Larger, multicenter, randomized studies with long-term follow-up are needed
- Article 4 take home points:
- Potential association of ICI therapy, originally used in cancer treatment, with significant reduction of clinical AKs
- Observed reduction in cSCCs occurrence was not statistically significant
- Underscore ICIs potential as a novel approach to mitigating field cancerization in high-risk populations
Dr. Lydia Luu (University of Minnesota) and Dr. Igor Kapetanovic (University of Minnesota) present the best dermatologic surgery relevant literature from the April Journals:
- Article 1: Deep Learning for Automated Segmentation of Basal Cell Carcinoma on Mohs Micrographic Surgery Frozen Section Slides
- Article 2: A New Twist on the Surgeon's Knot: Quantifying Suture Security
- Article 3: Oncologic outcomes for invasive squamous cell carcinoma with a clinically resolved biopsy site managed by watchful waiting: A retrospective cohort study
- Article 4: Immune Checkpoint Inhibitors in Field Cancerization and Keratinocyte Cancer Prevention
March 2025
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- Article 1 take home points:
- 9.4% of melanomas are upstaged from initial biopsy to definitive excision
- This upstaging may require further surgical or medical management, and may be associated with increased mortality
- It is important to obtain an adequate initial biopsy when suspicious for melanoma
- Article 2 take home points:
- There are differences in recurrence and survival outcomes between patients with NAAM vs DNAM
- Patients with NAAM are more likely to have melanomas on the sole, and exhibit longer RFS and OS compared to patients with DNAM
- Biological mechanisms behind these differences remain unclear and further basic research is needed
- Article 3 take home points:
- MCC-AJCC pathological staging criteria can risk stratify DSD better than OS
- Multiple patient and tumor features are predictive of DSD, beyond AJCC tumor features alone
- Incorporating these additional features into a multivariable FG model enhances the prognostic utility of current MCC staging
- Non-staging features should be considered in future research
- Article 4 take home points:
- It could not be concluded that SC + IMQ is non-inferior to SE, but SC + IMQ was substantially less effective than SE.
- Most treatment failures occurred in the first year after treatment
- Probability of tumor-free survival 5 years after treatment with SC + IMQ was still 77.8%
Dr. Lydia Luu (University of Minnesota) and Dr. Igor Kapetanovic (University of Minnesota) present the best dermatologic surgery relevant literature from the March Journals:
- Article 1: Tumor upstaging in invasive melanoma is associated with changes in clinical management and worse prognosis
- Article 2: Nevus-associated acral melanoma has lower risk of recurrence and mortality than de novo acral melanoma: A multicenter, retrospective analysis of 482 patients
- Article 3: A multivariable disease-specific model enhances prognostication beyond current Merkel cell carcinoma staging: An international cohort study of 10,958 patients
- Article 4: Imiquimod Cream Preceded by Superficial Curettage vs Surgical Excision for Nodular Basal Cell Carcinoma: A Secondary Analysis of a Randomized Clinical Trial
February 2025
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- Article 1 take home points:
- Earlier pedicle division did not have increased complications
- Differences in medical history between groups, though not statistically significant
- Potential to enhance quality of life for patients
- Article 2 take home points:
- Enhanced treatment response of SCCis with 5FU with longer treatment duration and smaller tumor size
- Article 3 take home points:
- Existing literature on this topic demonstrates conflicting results
- This study found no significant reduction in total MMS stages using dermoscopy and did not improve lateral/deep margin assessment
- There may be a role for other noninvasive imaging modalities, and future studies on these modalities could be helpful
- Article 4 take home points:
- Patients with lesions 0.8-mm to 1.0-mm thick had a significantly higher relative risk of melanoma-related death compared with patients with lesions smaller than 0.8 mm
- First analysis to use methods that take into account the competing risk of death from other causes
- The authors suggest that a change of the T1 threshold from 1 mm to 0.8 mm should be considered when the AJCC staging system is next reviewed
- Approximately 1 in 4 melanoma-related deaths occurred after 10 years, emphasizing the importance of long-term follow-up for patients with T1 melanomas
Dr. Katherine Thompson, Dr. Shanelle Briggs, and Dr. Daniel Knabel present the best dermatologic surgery relevant literature from the February Journals:
- Article 1: Accelerated Takedown of Melolabial Interpolation Flaps at 1 to 2 Weeks, Indications and Safety for Improved Patient Experience
- Article 2: 5-fluorouracil 5% cream for squamous cell carcinoma in situ: Factors impacting treatment response
- Article 3: Surgical Margins of Nonmelanoma Skin Cancers in Mohs Surgery: Dermoscopy Versus Naked Eye
- Article 4: Risk of Death Due to Melanoma and Other Causes in Patients With Thin Cutaneous Melanomas
January 2025
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- Article 1 take home points:
- Hemostasis with fewer limitations and reduced risk of bleeding vs. traditional methods
- Systematic review shows positive results in patient outcomes, reducing surgical time and increasing overall patient satisfaction
- Establishing standardized protocols and guidelines for use of TXA in MMS
- Article 2 take home points:
- EMPOWER-CSCC-1 is the largest prospective data set to date on long term efficacy and safety for an anti-PD1 therapy in advanced CSCC
- Cemiplimab provides clinically meaningful activity in both mCSCC and laCSCC as evidenced by ORR, DOR, and PFS
- Close monitoring of this patient population for AE is imperative
- Article 3 take home points:
- Mohs is a promising surgical approach for the treatment of malignant adnexal tumors of the skin.
- Article 4 take home points:
- N/A
Dr. Igor Kapetanovic (University of Minnesota) and Dr. Lydia Luu present the best dermatologic surgery relevant literature from the January Journals:
- Article 1: Tranexamic Acid in Mohs Micrographic Surgery: A Systematic Review
- Article 2: A phase 2 open-label study of cemiplimab in patients with advanced cutaneous squamous cell carcinoma (EMPOWER-CSCC-1): Final long-term analysis of groups 1, 2, and 3, and primary analysis of fixed-dose treatment group 6
- Article 3: Enhanced Disease-Specific Survival Among Individuals With Malignant Adnexal Tumors of the Skin Treated With Mohs Surgery: A National Database Study
- Article 4: Efficacy of 0.25% Lidocaine Versus 0.5% Lidocaine in Dermatologic Surgery: A Double-Blind, Randomized Controlled Trial
To view earlier recordings in the Journal Club archive, click the desired year below.
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