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Updated: May 7, 2026
Establishment of a Clinic-based Biorepository
Published on: May 29, 2017
Adverse events associated with mohs micrographic surgery: multicenter prospective cohort study of 20,821 cases at 23
Murad Alam1, Omer Ibrahim2, Michael Nodzenski3
1Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois2Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois3Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois4Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
Importance:
Detailed information regarding perioperative risk and adverse events associated with Mohs micrographic surgery (MMS) can guide clinical management. Much of the data regarding complications of MMS are anecdotal or report findings from single centers or single events.
Objectives:
To quantify adverse events associated with MMS and detect differences relevant to safety.
Design, Setting, And Participants:
Multicenter prospective inception cohort study of 21 private and 2 institutional US ambulatory referral centers for MMS. Participants were a consecutive sample of patients presenting with MMS for 35 weeks at each center, with staggered start times.
Exposure:
Mohs micrographic surgery. MAIN OUTCOMES AND MEASURES Intraoperative and postoperative minor and serious adverse events.
Results:
Among 20 821 MMS procedures, 149 adverse events (0.72%), including 4 serious events (0.02%), and no deaths were reported. Common adverse events reported were infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events.
Conclusions And Relevance:
Mohs micrographic surgery is safe, with a very low rate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate. Common complications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely during MMS. We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changes would be cost-effective given the small risk reductions.
Insights
Mohs micrographic surgery (MMS) is a safe procedure with a very low rate of adverse events and no reported deaths. Common complications like infections and bleeding are manageable, even for patients on anticoagulation therapy.
Area of Science:
- Dermatology
- Surgical Oncology
- Patient Safety
Background:
- Limited data exists on perioperative risks and adverse events associated with Mohs micrographic surgery (MMS).
- Existing data is often anecdotal or from single-center studies.
- Quantifying adverse events is crucial for guiding clinical management and improving patient safety.
Purpose of the Study:
- To quantify the incidence of adverse events during Mohs micrographic surgery.
- To identify specific complications and their frequencies.
- To detect safety-related differences in adverse events associated with MMS.
Main Methods:
- A multicenter prospective inception cohort study was conducted.
- Data was collected from 21 private and 2 institutional US ambulatory referral centers.
- 20,821 consecutive Mohs micrographic surgery procedures were analyzed over 35 weeks.
Main Results:
- A total of 149 adverse events (0.72%) were reported, including 4 serious events (0.02%) and no deaths.
- The most common adverse events were infections (61.1%), dehiscence/necrosis (20.1%), and bleeding/hematoma (15.4%).
- Patients on anticoagulation therapy experienced more bleeding and wound-healing complications, which were safely managed.
Conclusions:
- Mohs micrographic surgery demonstrates a high safety profile with minimal adverse and serious event rates.
- Infections, impaired wound healing, and bleeding are the most frequent complications.
- While certain practices like antiseptic use may reduce risk, their clinical significance and cost-effectiveness require further evaluation.