Incidental Histologic Findings During Mohs Micrographic Surgery: A Systematic Review.

Background: Mohs micrographic surgery (MMS) allows for precise excision of skin cancers with intraoperative histologic margin assessment. Incidental findings-unexpected histopathologic features unrelated to the primary lesion-are occasionally discovered but scantily characterized in the literature.

Objective: To systematically review published cases of incidental histologic findings identified during MMS, with attention to their frequency, clinical implications, and management.

Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines utilizing PubMed, Wiley Online Library, Google Scholar, and Cochrane Library. Data were extracted regarding patient demographics, tumor type and location, incidental findings, associated implications, treatment, and follow-up.

Results: Twenty-nine studies were selected for inclusion, describing 680 patients (aged 36-90 years) with incidental findings, of which 26 were findings distinct from the original tumor. One study reported 610 patients with incidental basal and squamous cell carcinoma. Among the remaining 28 studies, the most frequent incidental findings included benign syringomatous hyperplasia, syringomas, Merkel cell carcinoma, and melanoma, with further treatment required for 15.7% of these incidental findings (11/70). In aggregate, 91.3% of reported incidental findings required further treatment (621/680).

Conclusion: Incidental findings during MMS can be clinically important. Although many are benign, others may alter prognosis and management. Awareness of these findings and standardized reporting may enhance patient outcomes.