George M. Jeha

Postoperative wound care following Mohs micrographic surgery (MMS) has high variability and surprisingly limited real‐world evidence. Despite over one million MMS procedures performed annually in the United States, recommendations for topical agents, pressure dressings, wound cleansing, dressing change frequency, activity restrictions, and wound check intervals vary substantially across practices and are frequently based on training tradition rather than clinical data. This narrative review critically evaluates 15 common post‐Mohs wound care practices, characterizing the evidence quality for each. Six practices are supported by at least Level III evidence, most notably plain petrolatum over topical antibiotics and over multi‐ingredient ointments such as Aquaphor, gentle soap‐and‐water cleansing, the safety of early showering, targeted acetic acid soaks for hypergranulation tissue, and virtual wound checks. Evidence discourages cytotoxic antiseptics such as hydrogen peroxide and Dakin's solution. Most other common postoperative practices, including pressure dressings, activity restrictions, and dressing change frequency, remain understudied in MMS. Standardizing established practices while transparently acknowledging areas of uncertainty may reduce patient confusion, improve outcomes, and highlight priorities for future prospective research in dermatologic surgery. image

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Cosmetic dermatologic products and procedures are increasingly utilized by women of reproductive age, including those who are pregnant or lactating. Pregnancy and lactation are associated with hormonal, vascular, and immunologic changes that may alter skin biology, cutaneous absorption, and susceptibility to adverse effects. Despite growing demand, clinicians frequently face uncertainty when counseling patients regarding cosmetic interventions, as high‐quality safety data and formal guidelines remain limited. This review summarizes the available evidence and practical counseling considerations for commonly used topical agents, chemical peels, injectable neuromodulators and fillers, lasers and light‐based therapies, and energy‐based devices, while proposing a practical counseling framework that distinguishes recommendations between pregnancy and lactation. This distinction is critical, as these states are often conflated despite differing pharmacokinetic profiles and safety considerations. Unlike a systematic review, this narrative review qualitatively synthesizes the available literature while emphasizing clinically applicable counseling. The published literature largely consists of observational studies, case reports, and extrapolation from nonpregnant populations, reflecting the ethical and practical limitations of conducting controlled trials in these populations. Overall, pregnancy and lactation should not be approached as equivalent counseling states. During pregnancy, elective cosmetic interventions are deferred, and pregnancy‐related physiologic changes may alter both treatment risk and cosmetic outcome. During lactation, many interventions may be considered following individualized risk assessment when systemic exposure is expected to be minimal, and treatment sites avoid direct infant contact. Counseling should emphasize conservative management, transparent discussion of uncertainty, and shared decision‐making tailored to the patient's reproductive status and treatment goals. image

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Mohs micrographic surgery (MMS) is a highly specialized skin cancer procedure that combines complete microscopic margin assessment with maximal preservation of uninvolved tissue. The technique is based on staged excision of the tumor with systematic horizontal sectioning and real-time examination of the entire peripheral and deep surgical margins, allowing further tissue removal only in areas where residual tumor is identified. Its unique strength lies in the ability to detect subclinical tumor extensions that may be missed by conventional excision and standard vertical sectioning, thereby improving local control while minimizing unnecessary tissue sacrifice. Since its introduction in the 1930s by Frederic E. Mohs, the technique has evolved into a cornerstone of modern dermato-oncology, particularly for tumors arising in anatomically critical areas, recurrent neoplasms, and histologically aggressive malignancies. MMS is now widely regarded as the treatment of choice for high-risk basal cell carcinoma and cutaneous squamous cell carcinoma because of its superior cure rates and tissue-sparing approach. Beyond its oncologic advantages, MMS allows precise clinicopathologic correlation and immediate reconstruction tailored to the final defect, contributing to favorable functional and cosmetic outcomes. As experience with the technique has expanded, so too has interest in adjunctive tools for preoperative tumor delineation and margin control, further refining patient selection and surgical accuracy. Overall, MMS represents an essential advance over conventional excision for selected cutaneous malignancies, offering an optimal balance between radical tumor clearance and preservation of normal tissue.

I was accepted into my fellowship almost 1 year ago: major milestones on my curriculum vitae are now met, fellowship application materials are complete, and the