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A Predictive Model for Primary Closure Lengths in Mohs Surgery Based on Skin Cancer Type, Dimensions, and Location.

Zachary A Theroux1, Adam B Blechman2, Mark A Russell1

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Preoperative lesion circumference best predicts surgical scar length after Mohs micrographic surgery (MMS) for nonmelanoma skin cancers (NMSCs). This finding aids surgeons in planning wound reconstruction and patient counseling.

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Area of Science:

  • Dermatology
  • Surgical Oncology
  • Plastic Surgery

Background:

  • Surgical scar length is a significant patient concern following Mohs micrographic surgery (MMS).
  • Accurate prediction of post-surgical defect size is crucial for effective reconstruction planning.

Purpose of the Study:

  • To identify the preoperative lesion size metric that best correlates with primary linear closure length in nonmelanoma skin cancers (NMSCs) treated with MMS.
  • To develop predictive models for linear closure lengths across 10 distinct anatomical regions.

Main Methods:

  • Retrospective analysis of 4,049 NMSCs treated with MMS and repaired via primary linear closure.
  • Correlation of primary closure lengths with preoperative lesion circumference, area, and short axis length.
  • Application of linear regression analysis to establish predictive relationships.

Main Results:

  • Preoperative NMSC circumference demonstrated the strongest correlation with primary closure length.
  • Regression models indicated that closure length increases by 0.52 to 1.1 mm per millimeter increase in circumference, varying by anatomical location.
  • Twenty-one of 28 regression models achieved coefficients of determination (R) above 0.5, indicating good predictive power.

Conclusions:

  • Preoperative lesion circumference is a reliable predictor of primary closure length in MMS for NMSCs.
  • Anatomical areas like the nasal tip, supratip, and periocular regions are most sensitive to variations in NMSC size.
  • These findings can assist Mohs surgeons in preoperative planning, wound reconstruction, and patient communication regarding expected outcomes.