Complications After Mohs Micrographic Surgery in Patients Aged 85 and Older

Abstract

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.

A critical re‐evaluation of Mohs micrographic surgery for a facial basal cell carcinoma in older adults: Should we waive this treatment in certain patients?

“…Only 2.4% of the patients experienced a complication after their MMS, which is similar to the complication rates reported in literature. 11 This confirms that a MMS is a safe procedure, even in older adults, as also illustrated in previous studies. 12,13 Previous data have shown; however, contradictory results whether or not MMS should still be considered in older adults.…”

“…Complications were evaluated retrospectively in this cohort study. Only 2.4% of the patients experienced a complication after their MMS, which is similar to the complication rates reported in literature 11 . This confirms that a MMS is a safe procedure, even in older adults, as also illustrated in previous studies 12,13 .…”

Dermatosurgery – from surgical option to integral part of dermatologic therapy

“…Micrographic surgery using frozen sections, which in its classic form is equivalent to Mohs micrographic surgery, has become the method of choice worldwide for the treatment of BCC and SCC in the H-zone of the face, as well as for all scirrhous or desmoplastic tumors. 25,26 Microscopically controlled surgery (MCS) with formalin fixation and paraffin sections achieves the lowest local recurrence rates, as does Mohs surgery. The pioneering work at the Department of Dermatology of the University of Tübingen in Germany has made the "Tübinger Torte" (cake method) and other 3D techniques a globally recognized model for MCS.…”

Dermatochirurgie – von der operativen Alternative zum integralen Bestandteil der dermatologischen Therapie

“…Die mikrographische Chirurgie am Schnellschnitt, die in ihrer klassischen Form mit der Mohs surgery gleichgesetzt wird, hat sich weltweit als Methode der Wahl zur Behandlung des Basalzellkarzinoms (BZK) und des PEK im Bereich der H-Zone des Gesichts, sowie aller szirrhösen beziehungsweise desmoplastischen Tumoren etabliert. 25,26 Die mikroskopisch kontrollierte Chirurgie (MKC) mit Formalin-Fixation und Paraffin-Schnitten erzielt in gleicher Weise wie die Mohs surgery die geringsten Lokalrezidiv-Raten. Die Pionierarbeit an der Universitäts-Hautklinik Tübingen hat der "Tübinger Torte" und anderen 3D-Verfahren als Vorbild für die MKC weltweite Anerkennung verschafft.…”