BACKGROUND As the US population ages, safe surgical procedures are necessary for treatment of cutaneous neoplasms in very elderly patients. OBJECTIVE To determine the incidence of complications associated with Mohs micrographic surgery (MMS) in patients aged 85 and older, and the risk factors that predispose to complications. METHODS A 9-year retrospective chart review of patients aged 85 and older who underwent MMS at our institution between 07/2007 and 11/2016 was performed. Six types of complications associated with scalpel-based cutaneous surgery were recorded, as well as patient, tumor, and repair characteristics. RESULTS This study included 949 patients totaling in 1683 MMS cases. There were 30 complications: infection (N = 11), wound dehiscence (N = 6), hematoma (N = 6), hemorrhage (N = 5), flap necrosis (N = 1), and graft necrosis (N = 1), resulting in an overall complication rate of 1.78%. Independent risk factors associated with a statistically higher incidence of complications were anticoagulant use (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.26–6.13; p = .012), extremity location (OR, 2.80; 95% CI, 1.19–6.54; p = .018), greater than 2 MMS stages (OR, 2.43; 95% CI, 1.08–5.46; p = .032), and flap repair (OR, 2.27; 95% CI, 1.05–4.90; p = .036). CONCLUSION Mohs micrographic surgery is a safe procedure for treatment of cutaneous neoplasms in the very elderly.

BACKGROUND Typical prophylactic coverage of suspected cutaneous surgical-site infections (SSIs) predominantly covers gram-positive bacteria. Data regarding the frequency of infection with unusual bacteria, not covered by prophylaxis, are not available. OBJECTIVE A retrospective 10-year review of culture-positive infections at a single academic site was performed. MATERIALS AND METHODS All positive bacterial culture results at the Washington University Center for Dermatologic and Cosmetic Surgery between October 31, 2007, and October 31, 2017, were collected and analyzed. RESULTS Coagulase-negative staphylococcus accounted for 20.8% of positive culture results. Staphylococcus aureus caused 45.4% of infections. The remaining 33.8% were due to non–S. aureus bacteria, most frequently with Pseudomonas aeruginosa (10.8%). Numerous other gram-negative organisms and unusual gram-positive organisms were cultured. The lower extremity and ear were the only sites more likely to be infected with non–S. aureus bacteria. Smokers and immunosuppressed individuals were not more likely to have an SSI with non–S. aureus bacteria. CONCLUSION A significant proportion of all SSIs with positive culture results was due to bacteria that are not sensitive to beta-lactam prophylaxis. Broader coverage for suspected SSI should be considered, particularly on the lower extremity and ear.

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The epithelioid hemangioma, more commonly termed angiolymphoid hyperplasia with eosinophils, is a pathologic vascular proliferation characterized by a distinctive eosinophil-rich mixed inflammatory infiltrate. A nonspecific accompanying infiltrate has only rarely been reported, and may confound the diagnosis of this benign process with malignant mimics. We present such a case of angiolymphoid hyperplasia without eosinophils, and consider its diagnosis and pathogenesis within the spectrum of related entities.