Difficulty with surgical site identification: what role does it play in dermatology?

The potential for wrong-site surgery is a growing concern in dermatology.

The purpose of this study was to determine the incidence of difficulty with surgical site identification and possible confounding factors.

This was a prospective study on 333 Mohs cases performed between April 1, 2009, and February 9, 2010. Data collection forms were used on the day of surgery to record the difficulty associated with surgical site identification and potential confounding factors.

Of the 333 patients evaluated, 9% were unable to identify their surgical sites. The majority of cases (88.5%) were located on the head and neck. When comparing patients who were able to identify their site and those who were not, there was a statistically significant difference (P = .035) in the percentage of lesions residing in a location visible to the patient. Those who were able to see their biopsy sites were 3.5 times more likely to identify their surgical site. Of the 47.6% of patients with chart notes, only 5% of these cases were photographs and 23% had high-quality diagrams. Although a delay in treatment of greater than 3 months from the original biopsy site was higher among those with difficulty in identifying their surgical site, this was not found to be statistically significant.

We believe our sample size was not large enough to show a significant link between difficulty with surgical site identification and several likely confounding factors.

We have shown that at least 9% of patients presenting for Mohs micrographic surgery are unable to confidently identify their surgical sites.