Mohs chemosurgery is minimally invasive and relatively simple. This method has been applied widely in areas such as palliative care and is considered a very useful treatment
. Although no guiding philosophy exists regarding the use interval and contact time with Mohs paste, the progress and depth of consolidation depend on contact time. Reported contact times range from a few minutes to 48 hours
. Hemostatic effects have been seen with times ranging from a few minutes to 10 minutes
. The intended purpose of Mohs paste application is to determine the appropriate use interval and contact time. When using Mohs paste, it is important to protect normal, healthy skin. Several methods for containing the oil, such as thick application of petroleum jelly or affixing dressing agents, have been applied
. For the formulation of Mohs paste, a saturated solution of zinc chloride (purified water:zinc chloride, 1mL:2g) was made, then mixed with zinc oxide starch powder, and the viscosity was adjusted using glycerin. This preparation method allowed the production of a roughly common product. With the aim of tumor reduction, a relatively long contact time (24 hours) was determined and the concentration was reduced to 50%, instead of a saturated solution, for the purpose of achieving slow infiltration. Tissue fixation can be obtained even at concentrations of 50%; therefore, a saturated solution was deemed unnecessary. After using Mohs paste, necrotic tissue is formed. In many cases, necrotic tissue is removed bluntly, without local anesthesia, or it falls off naturally. After removal, an ulcer might form, and exudates might reduce; however, regular dressing changes remain necessary.
Closure therapy was performed according to pressure ulcer protocol using Versiva® XC®. Versiva® XC® is an adhesive patch, with reported effectiveness; it creates a moist environment to promote wound healing and can protect the surrounding environment by containing the exudate
. Daniels et al. demonstrated ease-of-use and no problems with use of the patch for an average of between 5 and 6 days
. Similarly, the present patients experienced no problems with weekly dressing changes in the out-patient setting. Complete epithelialization was achieved in Case 1. In Case 2, complete closure was not achieved due to a decline in the antitumor effects of docetaxel, but weekly dressing changes could be continued without complications such as infection. Versiva® XC® is a useful dressing in the out-patient setting.
In breast cancer treatment, few experiences have been reported with the primary goal of cytoreduction. To the best of our knowledge, radical surgery after a combination of systemic therapy and Mohs chemosurgery has not been reported. In skin tumor resection, Mohs chemosurgery is not a first-line choice, but good results have also been reported
[5, 15, 16]. For patients with locally advanced breast cancer, multidisciplinary treatment should be applied. However, Mohs chemosurgery can aid in tumor reduction when combined with multidisciplinary treatment in patients with no distant metastases. In particular, Mohs chemosurgery is a useful method in patients with bleeding and exudates.