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A prospective evaluation of the incidence of complications associated with Mohs micrographic surgery
Jonathan L Cook1, Jennifer B Perone
1Division of Dermatology, Department of Medicine, Duke University Medical Center, Box 3915, Durham, NC 27710, USA. jonathan.cook@duke.edu
Background:
Because outpatient surgery is being increasingly scrutinized in the lay press, it is important that dermatologists and dermatologic surgeons accurately characterize the safety of office-based surgery. Although there is abundant anecdotal evidence to support the inherent safety of dermatologic surgery, there are few data that support the safety of Mohs micrographic surgery (MMS) as performed by appropriately trained dermatologic surgeons in outpatient settings.
Design:
All patients presenting for MMS micrographic surgery during the calendar year 2000 were prospectively enrolled in this study designed to evaluate the incidence of multiple complications associated with scalpel-based cutaneous surgery (postoperative hemorrhage, hematoma formation, wound infection, wound dehiscence, and flap/graft necrosis).
Setting:
An academic MMS practice.
Patients:
A total of ,1052 patients (1,358 MMS cases) were prospectively enrolled. Complete follow-up information was available for 1,343 cases (98.9%).
Results:
Complications associated with MMS were very infrequent, with an overall complication incidence of 1.64% (22/1,343). Most surgical complications involved difficulties with hemostasis. No complications were significant enough to involve the assistance of another specialist or to require the hospitalization of the patient.
Conclusions:
Mohs micrographic surgery is a very safe outpatient procedure when performed by appropriately trained physicians. The types of complications seen in our patients were identical to those seen in hospitalized patients described in previous studies. Our complication rates were equal to or lower than the published complication rates from specialists in other surgical disciplines.
Insights
Mohs micrographic surgery (MMS) is a safe outpatient procedure. Complications are infrequent and minor when performed by trained dermatologic surgeons, with rates comparable to other surgical disciplines.
Area of Science:
- Dermatology
- Surgical Oncology
- Cutaneous Surgery
Background:
- Office-based surgery faces increasing scrutiny.
- Limited data exist on the safety of Mohs micrographic surgery (MMS) in outpatient settings.
- Anecdotal evidence suggests dermatologic surgery is safe.
Purpose of the Study:
- To evaluate the incidence of complications in Mohs micrographic surgery (MMS).
- To characterize the safety of outpatient dermatologic surgery.
Main Methods:
- Prospective enrollment of 1,358 MMS cases from 1,052 patients in 2000.
- Evaluation of complications including hemorrhage, hematoma, infection, dehiscence, and necrosis.
- Data collected from an academic MMS practice with 98.9% follow-up.
Main Results:
- Overall complication incidence was 1.64% (22/1,343 cases).
- Most complications involved hemostasis issues.
- No complications required specialist assistance or hospitalization.
Conclusions:
- Mohs micrographic surgery is a highly safe outpatient procedure when performed by trained physicians.
- Complication types and rates are comparable to hospitalized patients and other surgical specialties.
- Supports the safety of office-based dermatologic surgery.