Navigating the Art of Mohs Surgery: Balancing Risks and Scar Resilience

Original Article: Complications Associated with Mohs Micrographic Surgery: Data from the Nationwide Prospective Cohort REGESMOHS

What are the key takeaways of this article?

There are limited comprehensive studies examining the safety of Mohs micrographic (MMS) surgery, a skin cancer removal technique. Since previous studies have only focused on singular adverse events, a nationwide prospective cohort study investigated the risk of various MMS complications and their risk factors. Specifically, the authors thoroughly explored mid-term scar alterations and functional loss post-MMS.

In this recent study, the authors gathered data on all adverse events across 5,017 patients from 22 specialized centers, amounting to 14,421 patient-years of follow-up. The results revealed that 7.0% experienced perioperative morbidity, while 6.5% encountered mid-term and scar-related complications, shedding light on the overall risk landscape associated with MMS. The study also identified risk factors for complications, such as the use of antiaggregant/anticoagulant medications and large tumour sizes. A larger tumour size may impact other structures and therefore requires complex surgical repairs. Interestingly, age and outpatient setting did not influence the incidence of adverse events.

Furthermore, the study highlighted risk factors associated with varying outcomes. For outcomes of hemorrhages, occurring in 0.9% of cases, risk factors included the use of antiaggregant/anticoagulant therapy, tumor size, longer surgery duration, and incomplete procedures. Wound necrosis (1.9%) and dehiscence (1.0%) were more prevalent in cases involving larger defects and complex closures. Wound infections (0.9%) correlated with surgeries penetrating deeper structures, larger tumors, and previous surgical interventions. Surprisingly, immunosuppression solely elevated the risk of necrosis.

Moreover, the analysis showed intriguing insights into scar-related alterations. Aesthetic scar changes (5.4%) were more common among younger patients with larger tumors. Functional scar alterations (1.7%) affecting daily functioning were associated with factors such as general anesthesia, larger tumors with prior surgeries, and procedures involving flaps or complex closures.

In conclusion, the study found a generally low risk of complications associated with MMS. Most risk factors related to tumor size and depth, thereby necessitating complex surgeries. This finding highlights the importance of meticulous procedures for larger or deeper tumors. Additionally, while the intake of antiaggregant/anticoagulant medications slightly increased hemorrhage risk, it was not significant enough to recommend withdrawal. The finding that age and outpatient settings did not contribute to adverse event risks challenges previous assumptions. Overall, this investigation significantly contributes to understanding the nuanced landscape of complications post-MMS. It provides valuable insight into critical factors influencing outcomes that can guide decision-making in clinical practice.

Publication Date: December 17th, 2023

Reference: Ruiz-Salas, V., Sanmartin-Jiménez, O., Garcés, J. R., Vilarrasa, E., Miñano-Medrano, R., Escutia-Muñoz, B., Flórez-Menéndez, Á., Artola-Igarza, J. L., Alfaro-Rubio, A., Redondo, P., Delgado-Jiménez, Y., Sánchez-Schmidt, J., Allende-Markixana, I., García Bracamonte, B., De La Cueva-Dobao, P., Ciudad, C., Carnero-González, L., Vázquez-Veiga, H., Sánchez-Sambucety, P., … on behalf of REGESMOHS (Registro Español de Cirugía de Mohs). (2022). Complications Associated with Mohs Micrographic Surgery: Data from the Nationwide Prospective Cohort REGESMOHS. Dermatology, 238(2), 320–328. https://doi.org/10.1159/000517010 

Summary By: Megan Lowe