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Background: The American Society for Dermatologic Surgery (ASDS) International Traveling Mentorship Program (ITMP) has initiated an International Mohs Fellowship Recognition Program, with 3 centers accredited to date., Objective: To describe and compare the outcomes of Mohs micrographic surgery (MMS) at the three units., Methods: From patient files, we extracted demographic information, as well as tumor type, location of tumor, tumor histology, stages of MMS, and outcomes., Results: At the 3 units, 3,899 patients were treated with MMS over a 5-year period in the South African unit, and 1,141 cases in the Romanian unit. Over a 3-year period, 849 cases were treated in the Netherlands unit. Basal cell carcinomas (BCCs) constituted 78.9% (South African unit), 79% (Romanian unit), and 97.2% (Netherlands unit), and squamous cell carcinomas (SCCs) 17.7% (South African unit), 19% (Romanian unit), and 0.7% (Netherlands unit) of the tumors treated. The recurrence rate following MMS was low, at 0.1% (South African Unit) and 0.17% (Romanian Unit) of cases at the end of the study period, with a median follow-up time of 2 years., Conclusion: Mohs micrographic surgery is an effective treatment modality for removing BCC and SCC at ASDS ITMP-recognized International Mohs Fellowship units.

Background: Diffuse widespread actinic keratoses are difficult to treat, have a tendency toward higher recurrence rates, and therefore require ablative treatment. Laser resurfacing is one of the treatment modalities that can treat whole surface areas., Objective: To evaluate patients who underwent laser resurfacing for widespread actinic keratoses with long-term follow-up for recurrence rates, time until new lesions occur, and the most common side effects., Methods: Retrospective case-control study from 25 patients who underwent laser resurfacing for widespread actinic keratoses on the scalp, forehead, or full face at our department. Follow-up varied from 7 to 70 months. Recurrence rates, adverse effects, and improvement were analyzed through chart analysis., Results: The mean average follow-up was 39 months. Forty-four percent of the patient shad no recurrence during the time period. Fifty-six percent of the patients developed new lesions after treatment but only a few. Of the recurrences, 20% occurred within 1 year and 36% occurred after 1 year. The most common short- and long-term side effects were infections (12%), hypopigmentation (48%), hyperpigmentation (8%), acne (12%), milia (12%), scar formation (8%), and atrophic and/or easily bruised skin (20%)., Conclusion: Laser resurfacing is an effective treatment modality for diffuse widespread actinic keratoses with long-term recurrence-free intervals.

Background: Actinic keratosis is an exceedingly common premalignant lesion that can develop into squamous cell carcinoma. There is an increasing prevalence of actinic keratosis with increasing age. Numerous treatment options are available for the treatment of actinic keratosis on the scalp. Although we know that atrophic skin heals slowly, one should be careful but should not hesitate to treat., Objective: We present three patients with widespread actinic keratotic lesions on the atrophic bald scalp who received different treatments., Methods: Patient 1 was treated with medium-depth chemical peel, patient 2 with cryopeel, and patient 3 with CO2 laser resurfacing. In all patients, the entire surface area was treated., Results: Despite the different treatment methods used, all three patients had severely delayed wound healing as a complication. Remarkably, all patients had a prolonged period of re-epithelialization., Conclusion: Care has to be taken in patients with widespread actinic keratosis on the atrophic bald scalp when treating the entire surface area regardless the treatment modality.

Background: Mohs micrographic surgery (MMS) is a technique that offers excellent cure rates in the treatment of basal cell carcinoma (BCC). One of the reasons for its success is the 100% visualization of the resection margins. Still, recurrences do occur in 2% to 5% of the treated BCCs. It has been suggested that BCC cells in frozen sections stained with hematoxylin and eosin (H&E) may be missed., Objective: To determine whether an additional immunohistochemical staining with a cytokeratin marker (MNF 116) indicates BCC cells in sections in which the H&E-stained frozen sections were negative., Methods: The Mohs procedure was performed under standard conditions in which H&E-stained slides were judged by the Mohs surgeon and the pathologist. After the H&E slides where judged negative, an extra slide was stained using immunohistochemistry and a monoclonal antibody against cytokeratin (MNF 116)., Results: A total of 143 complete slides were stained and judged by two Mohs surgeons and a pathologist. One of the 143 slides stained with MNF 116 showed positive staining where the H&E slides were negative, which is 0.7% of the slides. However, this single slide represents a failure of nearly 2% of the treated patients., Conclusion: Frozen sections stained with H&E in MMS offer enough security in detecting BCC cells during surgery; however, adjuvant cytokeratin staining can be useful in very selected cases of aggressive growing BCC.