Mohs micrographic surgery as an alternative treatment method for cutaneous mucormycosis

Area of Science:

• Dermatology
• Mycology
• Surgical Oncology

Background:

• Mucormycosis is a life-threatening invasive fungal infection, particularly in immunocompromised individuals like organ transplant recipients.
• Aggressive angioinvasion and dissemination characterize mucormycosis, often necessitating extensive surgical debridement and antifungal therapy.
• The rising prevalence of organ transplantation increases the incidence of opportunistic mucormycosis.

Observation:

• A 64-year-old organ transplant patient presented with biopsy-proven cutaneous mucormycosis.
• Mohs micrographic surgery was employed, utilizing rapid Gomori methenamine silver staining for precise margin control.
• The surgical technique focused on tissue preservation while ensuring complete eradication of the fungal infection.

Findings:

• The patient experienced no recurrence of mucormycosis at the 1-year follow-up.
• Full preservation of extremity function was achieved post-surgery.
• The Mohs technique demonstrated effective local control of the cutaneous fungal infection.

Implications:

• Mohs micrographic surgery, combined with rapid fungal staining, presents a viable tissue-sparing approach for cutaneous mucormycosis.
• This surgical modality should be strongly considered for managing the cutaneous manifestations of mucormycosis, especially in high-risk patients.
• The findings suggest a potential reduction in morbidity associated with mucormycosis treatment through meticulous surgical techniques.