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Broader Practice Indications for Mohs Surgical Defect Healing by Secondary Intention: A Survey Study
Chetan Vedvyas1, Patricia L Cummings, Roy G Geronemus
1*Ronald O. Perelman Department of Dermatology, NYU Langone Medical Center, New York, New York; †Eisenhower Medical Center, Rancho Mirage, California; ‡Laser and Skin Surgery Center of New York, New York, New York.
Summary
Secondary intention (SI) healing for Mohs surgery defects may be appropriate for more cases than previously thought. Experienced surgeons utilize SI healing for larger, deeper wounds and specific patient/lesion factors.
Area of Science:
- Dermatologic Surgery
- Wound Healing
- Mohs Surgery
Background:
- Growing use of secondary intention (SI) healing for Mohs surgical defects beyond traditional guidelines.
- Need to define expanded indications for SI healing in dermatologic surgery.
Purpose of the Study:
- Characterize expanded guidelines for SI healing appropriateness in dermatologic surgery.
- Identify factors influencing the decision to use SI healing for Mohs defects.
Main Methods:
- Survey study distributed to 293 members of the American College of Mohs Surgery in 2015.
- Analysis of factors influencing surgeons' decisions regarding secondary intention healing.
Main Results:
- More experienced surgeons were more likely to use SI healing for deep and large wounds.
- SI healing is frequently chosen for patients with prior wound complications (dehiscence, necrosis, infection), previous excisions, or elderly status.
- Lesion characteristics like permanent section submission, high-risk, large, recurrent, or aggressive tumors also influence SI healing decisions.
Conclusions:
- Broader indications for secondary intention healing in Mohs surgery are likely appropriate.
- SI healing may be suitable for convex sites (scalp, lower extremity), deep/large wounds, and defects with complications.
- Patient-specific and lesional factors support expanded use of SI healing.