Identifying and managing those patients at risk for aborted mohs micrographic surgery

Treatment of nonmelanoma cutaneous carcinoma with Mohs micrographic surgery (MMS) is a well-recognized therapy. However, there are infrequent times when MMS must be aborted before achieving adequately clear margins. Reasons cited by those who have aborted MMS include patient discomfort and/or concern regarding damage to deeper structures.

A retrospective cohort was created consisting of patients who were referred for reconstructive procedures following MMS during a 4-year period. Patients who experienced aborted MMS were identified from this cohort, and a chart review performed.

The overall occurrence of aborted MMS in the community was significantly less than 1% with a cumulative frequency in this particular reconstructive cohort of 1.7%. Approximately one-third of patients had persistent tumor on subsequent treatment, and approximately 14% required multiple excisional procedures to clear tumor. Risk factors for experiencing aborted MMS include histology of dermatofibroma sarcoma protuberans, significant pain during MMS, and location of tumor over a cranial nerve. Follow-up failed to reveal recurrence after further treatment.

Preoperative identification of patients at risk for aborted MMS would allow for direct referral using surgical excision, hence decreasing anxiety, morbidity, and cost. A treatment algorithm is proposed for patients who experience aborted MMS.