Low rate of adverse events observed with Mohs micrographic surgery

Alam M. JAMA Dermatol. 2013;doi:10.1001/jamadermatol.2013.6255.

  • November 8, 2013

Mohs micrographic surgery was safe, with a very low rate of adverse events and few serious adverse events, according to study results involving more than 20,000 procedures.

Researchers conducted a prospective inception cohort study of Mohs micrographic surgery (MMS) centers throughout the United States. Twenty-one private centers and two institutional referral centers collected data from a consecutive sample of patients presenting with MMS for 35 weeks at each center. Clinicians studied 20,821 tumors.

Intraoperative and postoperative minor and serious adverse events were used as main outcomes and measures.

There were 149 adverse events (0.72%) among the MMS procedures, including four serious events (0.02%); no deaths were reported. Infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%) were the most common adverse events reported. Patients treated with anticoagulation therapy were most likely to experience bleeding and wound-healing complications.

There was a modest risk reduction associated with the use of chlorhexidine gluconate (P<.001), antibiotics (P<.001) and sterile gloves (P=.04) during MMS.

“This study provides, to our knowledge, the largest prospectively collected multicenter cohort sample of cutaneous neoplasms undergoing MMS,” the researchers concluded. “Bleeding and wound-healing issues are often associated with pre-existing 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.”

Disclosure: See the study for a full list of relevant financial disclosures.

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