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The MMS exam has 110 questions and runs 2 hours.
These 10 free MMS questions are organized by exam domain, so you can see how each part of the Subspecialty Certification in Mohs Micrographic Surgery blueprint is tested. Reveal the answer and explanation under each question.
The final pathology for a 1.6-cm cutaneous squamous cell carcinoma of the scalp documents well-differentiated tumor extending 7.4 mm below the granular layer of adjacent normal epidermis. It enters subcutaneous fat but does not extend beyond it. There is no perineural or bone invasion. Assign the primary-tumor categories under both the Brigham and Women's Hospital (BWH) system and AJCC eighth edition.
Correct answer: A - BWH T1; AJCC T3
At the scheduled Mohs visit for an infiltrative basal cell carcinoma of the nasal sidewall, only a smooth 3-mm scar remains. The diagnostic biopsy showed tumor at its deep edge, and photographs unequivocally identify the site. The patient is healthy and still wants definitive treatment. What should the surgeon recommend?
Correct answer: C - Proceed with the planned Mohs excision of the documented biopsy site.
A first-stage Mohs section shows basal cell carcinoma at the true peripheral surgical margin between 3 and 4 o'clock. Specimen orientation and tissue continuity are secure. Three sections cut farther into the same block contain no tumor. Which finding governs the next operative decision?
Correct answer: C - The mapped peripheral margin is positive and requires another targeted excision.
At follow-up after an excision near the lower mandibular border, a patient has an asymmetric smile because the right lower lip cannot be depressed. Lower-lip and chin sensation are normal; eyebrow elevation and forceful eyelid closure are preserved. This deficit most closely localizes to the:
Correct answer: B - Marginal mandibular branch of the facial nerve
A healthy 55-kg adult has received 18 mL of 1% lidocaine with epinephrine 1:100,000 during Mohs surgery. Closure would require another 26 mL of 0.5% lidocaine with epinephrine 1:200,000. All injections occur during the same session, and no other local anesthetic is used. Under conventional labeled dosing limits, which assessment is correct?
Correct answer: D - 310 mg total; proceed because the cumulative dose is below 7 mg/kg.
A 63-year-old man takes apixaban for a pulmonary embolism diagnosed five weeks ago. Mohs surgery is planned for a recurrent forearm squamous cell carcinoma, with a short linear closure anticipated. Renal function is normal, and there is no bleeding history. The surgeon and prescribing clinician agree that treatment should proceed under local anesthesia. Under the 2023 BSDS guidance, how should apixaban be managed?
Correct answer: D - Continue prescribed apixaban dosing and use meticulous local hemostasis.
Successive frozen sections from three different blocks develop a narrow, straight gap along the cutting direction at the same blade position. Tissue on either side is well preserved, and the anti-roll plate is clean and undamaged. The most targeted adjustment is to:
Correct answer: A - Move to an undamaged segment of the blade.
A rapidly enlarging, painless red-violet nodule on an older man's forearm contains dermal sheets of small blue cells with finely granular chromatin. The cells express synaptophysin and show paranuclear dot-like CK20 staining; TTF-1, SOX10, and CD45 are negative. Which diagnosis best fits this immunophenotype?
Correct answer: B - Merkel cell carcinoma
A nasal tumor contains basaloid nests with peripheral palisading and stromal retraction. These merge through a transition zone into invasive atypical squamous cells with intercellular bridges and keratinization. BerEP4 staining is strong in the basaloid component and progressively lost across the transition. The integrated diagnosis is:
Correct answer: D - Basosquamous carcinoma
Forty minutes after a deep periorbital repair, a patient develops severe orbital pain, rapidly decreasing vision, proptosis, and a relative afferent pupillary defect. Intraocular pressure is 48 mm Hg, and the globe is intact. A clinician trained in orbital decompression is present. Which intervention takes priority?
Correct answer: A - Immediate decompression with lateral canthotomy and inferior cantholysis.
The MMS exam also covers these domains. Drill them in the full free practice test:
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