Dermatologic Surgery and Cutaneous Oncology

Utilization of Frozen Section Biopsies Taken at Time of Mohs Surgery

The burden of nonmelanoma skin cancer (NMSC) is increasing in the US, with a 77% increase in NMSC diagnoses from 1994–2014¹ and more than 5.4 million NMSCs diagnosed in 2012 alone.² Ultraviolet irradiation induces a field cancerization effect to the skin, resulting in multiple primary NMSCs in patients with diffuse actinic damage.

Patients may present for Mohs surgery with lesions suspicious for NMSC in the skin surrounding a surgical site. Since 2015, Cleveland Clinic Mohs surgeons at main campus and Avon Family Health Center performed 163 frozen section biopsies, revealing 114 additional NMSCs that were all treated on the day of the patient’s visit. All specimens are also submitted for permanent pathology to confirm the diagnosis with 100% concordance. This practice of performing a shave biopsy, diagnosing the tissue using frozen sections, and offering same-day treatment provides a cost-effective, patient-centered workflow, which increases quality of care by minimizing the chance of tumor recurrence and allowing all reconstructive options after tumor excision.

Biopsies Analyzed with Frozen Sections at Time of Mohs Surgery (N = 163)


Additional Tumors Diagnosed and Treated at Time of Mohs Surgery (N = 114)

2015 – 2020

  1. Mohan SV, Chang AL. Advanced basal cell carcinoma: epidemiology and therapeutic innovations. Curr Dermatol Rep. 2014; 3(1): 40-45.

  2. Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence estimate of nonmelanoma skin cancer (keratinocyte carcinomas) in the US population, 2012. JAMA Dermatol. 2015; 151(10):1081-1086.