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Complications After Mohs Micrographic Surgery in Patients Aged 85 and Older
Kathleen M Nemer1, James J Ko, Eva A Hurst
1All authors are affiliated with the Division of Dermatology, Washington University School of Medicine, St Louis, Missouri.
Background:
As the US population ages, safe surgical procedures are necessary for treatment of cutaneous neoplasms in very elderly patients.
Objective:
To determine the incidence of complications associated with Mohs micrographic surgery (MMS) in patients aged 85 and older, and the risk factors that predispose to complications.
Methods:
A 9-year retrospective chart review of patients aged 85 and older who underwent MMS at our institution between 07/2007 and 11/2016 was performed. Six types of complications associated with scalpel-based cutaneous surgery were recorded, as well as patient, tumor, and repair characteristics.
Results:
This study included 949 patients totaling in 1683 MMS cases. There were 30 complications: infection (N = 11), wound dehiscence (N = 6), hematoma (N = 6), hemorrhage (N = 5), flap necrosis (N = 1), and graft necrosis (N = 1), resulting in an overall complication rate of 1.78%. Independent risk factors associated with a statistically higher incidence of complications were anticoagulant use (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.26-6.13; p = .012), extremity location (OR, 2.80; 95% CI, 1.19-6.54; p = .018), greater than 2 MMS stages (OR, 2.43; 95% CI, 1.08-5.46; p = .032), and flap repair (OR, 2.27; 95% CI, 1.05-4.90; p = .036).
Conclusion:
Mohs micrographic surgery is a safe procedure for treatment of cutaneous neoplasms in the very elderly.
Insights
Mohs micrographic surgery (MMS) is safe for elderly patients aged 85+. The overall complication rate was 1.78%, with anticoagulant use and extremity location being significant risk factors for complications.
Area of Science:
- Dermatology
- Surgical Oncology
- Geriatric Medicine
Background:
- The aging US population necessitates safe surgical options for cutaneous neoplasms in the very elderly.
- Cutaneous neoplasms pose a significant health concern for elderly individuals, requiring effective and safe treatment modalities.
Purpose of the Study:
- To assess the incidence of complications following Mohs micrographic surgery (MMS) in patients aged 85 and older.
- To identify risk factors associated with complications in this elderly patient cohort undergoing MMS.
Main Methods:
- A 9-year retrospective chart review of patients aged 85+ who underwent MMS.
- Recorded complication types, patient demographics, tumor characteristics, and repair methods.
Main Results:
- The study included 949 patients and 1683 MMS cases, with an overall complication rate of 1.78%.
- Identified risk factors for complications included anticoagulant use, extremity tumor location, >2 MMS stages, and flap repair.
- Specific complications observed were infection, wound dehiscence, hematoma, hemorrhage, and flap/graft necrosis.
Conclusions:
- Mohs micrographic surgery demonstrates a favorable safety profile for treating cutaneous neoplasms in very elderly patients.
- Risk stratification and careful patient selection can further optimize outcomes for this demographic.
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