Mohs micrographic surgery: 10 year experience in Puerto Rico

The incidence of nonmelanoma skin cancer (NMSC) is increasing rapidly worldwide. As NMSC incidence increases, the modalities to treat this condition have become diverse. However, Mohs surgery remains the standard treatment for skin cancer in several particular locations such as the face. The objective of this study is to compare the changes, occurring over a 10-year period, in the characteristics of those cancers that were treated with Mohs micrographic surgery (MMS) at the dermatology clinics of the University of Puerto Rico as well as the modifications in the repair patterns used to close the surgical defects.

A retrospective chart review of patients treated with MMS at the dermatology of the University of Puerto Rico in the years 2000 and 2010. Variables analyzed include patient demographics, the anatomic site of each patient's lesion, pathology, the preoperative tumor size, the postoperative defect size, and the repair method.

Thirty-eight (38) patients in the year 2000 and 55 patients in the year 2010 were treated with MMS, signifying a 44% increase in this kind of treatment over a 10-year period. The 2000 cohort was found to be slightly older (P = 0.22), with no gender predominance (P = 0.44). In both years, the majority of tumors were located on the head and neck region, being the nose the most frequent site of involvement (P = 0.06). Basal cell carcinoma (BCC) was the most common neoplasm (P = 0.65). No statistical difference was found in preoperative tumor sizes (P = 0.27). More stages were required to remove a given tumor completely in the year 2000 (P = 0.025). Postoperative defects were smaller in 2000 (P = 0.027) than they were in 2010. Flap repair was used more often in 2010 (P = 0.001) than in 2000.

This study shows a trend toward larger defects in a slightly younger population of patients in the 2010 cohort compared to the 2000 cohort. It also demonstrates a reduction in the number of stages required to excise the tumors, and a tendency to reconstruct the surgical defects with flaps. However, the tumor types, preoperative tumor sizes, and anatomic sites of the lesions were all similar in the 2 cohorts.