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Chemosurgery: Microscopically Controlled Surgery for Skin Cancer

Kirby I. Bland, MD
JAMA. 1980;243(23):2442. doi:10.1001/jama.1980.03300490060033.
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This well-recognized authority on chemosurgery has completed the second text that addresses the primary therapy for a variety of skin neoplasms and infections. The term "chemosurgery" implies the basic application of systematic frozen-section analyses as a measure to guide complete microscopically controlled excision. This unique concept allows layer-by-layer excision of suspect tissues with microscopic scanning of the undersurface of each layer. The accepted principle of surgery dictates that microscopic guidance of excision selectively extirpates neoplastic foci that often extend considerable distances beyond clinically visible margins of the neoplasm. Zinc chloride paste (thus, the term "chemo") provides fixation in situ and facilitates excision and tissue sectioning. Since 1973, chemosurgery using fresh-tissue techniques has also allowed application of these principles in circumstances where the fixed tissue is not needed (mainly eyelid margins).

Mohs discusses the experimental background of microscopically controlled excision. He also details the technical considerations in chemosurgery, potential complications and


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