Murad Alam1, Omer Ibrahim2, Michael Nodzenski3, John M Strasswimmer4, Shang I Brian Jiang5, Joel L Cohen6, Brian J Albano4, Priya Batra7, Ramona Behshad8, Anthony V Benedetto9, C Stanley Chan7, Suneel Chilukuri10, Courtney Crocker11, Hillary W Crystal12, Anir Dhir13, Victoria A Faulconer13, Leonard H Goldberg14, Chandra Goodman15, Steven S Greenbaum16, Elizabeth K Hale17, C William Hanke18, George J Hruza19, Laurie Jacobson20, Jason Jones6, Arash Kimyai-Asadi14, David Kouba21, James Lahti22, Kristi Macias11, Stanley J Miller12, Edward Monk23, Tri H Nguyen24, Gagik Oganesyan5, Michelle Pennie25, Katherine Pontius20, William Posten26, Jennifer L Reichel20, Thomas E Rohrer27, James A Rooney28, Hien T Tran29, Emily Poon3, Diana Bolotin30, Meghan Dubina3, Natalie Pace3, Natalie Kim3, Wareeporn Disphanurat31, Ummul Kathawalla3, Rohit Kakar3, Dennis P West32, Emir Veledar33, Simon Yoo32. 1. Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois2Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois3Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois4Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois. 2. Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio. 3. Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 4. Dermatology Associates, PA, of the Palm Beaches, Delray Beach, Florida. 5. Division of Dermatology, Department of Medicine, University of California, San Diego. 6. AboutSkin Dermatology and Dermsurgery, Englewood, Colorado. 7. SkinCare Physicians of Chestnut Hill, Chestnut Hill, Massachusetts. 8. Laser and Dermatologic Surgery Center, Chesterfield, Missouri. 9. Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania12Dermatologic SurgiCenter, Philadelphia, Pennsylvania. 10. Bellaire Dermatology Associates, Houston, Texas14Department of Dermatology, Baylor University College of Medicine, Houston, Texas15Memorial Hermann Family Practice Residency Program, Columbia University College of Surgeons and Physicians, Manhattan, New York. 11. Bellaire Dermatology Associates, Houston, Texas. 12. currently in private practice, Towson, Maryland. 13. Dermatology Associates of Kentucky, PSC, Lexington. 14. DermSurgery Associates, PA, Houston, Texas. 15. Northwest Diagnostic Clinic, Houston, Texas. 16. Skin and Laser Surgery Center of Pennsylvania, Philadelphia21Department of Dermatology, Drexel University College of Medicine, Philadelphia, Pennsylvania22Department of Dermatology, Division of Dermatologic Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania. 17. New York University School of Medicine, New York, New York24Laser and Skin Surgery Center of New York, New York, New York. 18. Laser and Skin Surgery Center of Indiana, Carmel26Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis. 19. Laser and Dermatologic Surgery Center, Chesterfield, Missouri27Department of Dermatology, St Louis University School of Medicine, St Louis, Missouri. 20. Pacific Dermatology and Cosmetic Center, Seattle, Washington. 21. The Toledo Clinic Dermasurgery and Laser Center, Toledo, Ohio. 22. Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois30DPNS Surgical Center, Northbrook, Illinois. 23. Wesmed Medical Group, New Rochelle, New York. 24. Northwest Diagnostic Clinic, Houston, Texas32Department of Dermatology, MD Anderson Cancer Center, The University of Texas, Houston. 25. Department of Dermatology, University of Florida College of Medicine, Gainesville34Pennie Dermatology & Skin Surgery Center, Englewood, Florida. 26. Mohs Surgery Specialists, Dallas, Texas. 27. SkinCare Physicians of Chestnut Hill, Chestnut Hill, Massachusetts36Department of Dermatology, Brown University School of Medicine, Providence, Rhode Island. 28. currently in private practice, Atlanta, Georgia. 29. Seaside Dermatology and Skin Cancer Center, Irvine, California. 30. Section of Dermatology, Department of Medicine, University of Chicago, Chicago, Illinois. 31. Dermatology Unit, Department of Medicine, Thammasat University, Patumthani, Thailand. 32. Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois4Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois. 33. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Abstract
IMPORTANCE: Detailed information regarding perioperative risk and adverse events associated with Mohs micrographic surgery (MMS) can guide clinical management. Much of the data regarding complications of MMS are anecdotal or report findings from single centers or single events. OBJECTIVES: To quantify adverse events associated with MMS and detect differences relevant to safety. DESIGN, SETTING, AND PARTICIPANTS: Multicenter prospective inception cohort study of 21 private and 2 institutional US ambulatory referral centers for MMS. Participants were a consecutive sample of patients presenting with MMS for 35 weeks at each center, with staggered start times. EXPOSURE: Mohs micrographic surgery. MAIN OUTCOMES AND MEASURES Intraoperative and postoperative minor and serious adverse events. RESULTS: Among 20 821 MMS procedures, 149 adverse events (0.72%), including 4 serious events (0.02%), and no deaths were reported. Common adverse events reported were infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events. CONCLUSIONS AND RELEVANCE: Mohs micrographic surgery is safe, with a very low rate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate. Common complications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely during MMS. We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changes would be cost-effective given the small risk reductions.
IMPORTANCE: Detailed information regarding perioperative risk and adverse events associated with Mohs micrographic surgery (MMS) can guide clinical management. Much of the data regarding complications of MMS are anecdotal or report findings from single centers or single events. OBJECTIVES: To quantify adverse events associated with MMS and detect differences relevant to safety. DESIGN, SETTING, AND PARTICIPANTS: Multicenter prospective inception cohort study of 21 private and 2 institutional US ambulatory referral centers for MMS. Participants were a consecutive sample of patients presenting with MMS for 35 weeks at each center, with staggered start times. EXPOSURE: Mohs micrographic surgery. MAIN OUTCOMES AND MEASURES Intraoperative and postoperative minor and serious adverse events. RESULTS: Among 20 821 MMS procedures, 149 adverse events (0.72%), including 4 serious events (0.02%), and no deaths were reported. Common adverse events reported were infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events. CONCLUSIONS AND RELEVANCE: Mohs micrographic surgery is safe, with a very low rate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate. Common complications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely during MMS. We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changes would be cost-effective given the small risk reductions.
Authors: Murad Alam; Joel L Cohen; Brian Petersen; Daniel I Schlessinger; Alexandra Weil; Sanjana Iyengar; Emily Poon Journal: JAMA Dermatol Date: 2017-08-01 Impact factor: 10.282
Authors: Matthew Q Miller; Abel P David; James E McLean; Stephen S Park; Jared Christophel Journal: JAMA Facial Plast Surg Date: 2018-03-01 Impact factor: 4.611