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Systematic review of Mohs micrographic surgery in children: Identifying challenges and practical considerations for
Hanieh Zargham1, Amor Khachemoune1
1Division of Dermatology, McGill University Health Center, Montreal, Quebec, Canada; Department of Dermatology, University of New York Downstate and Veterans Affairs Medical Center, Brooklyn, New York.
Background:
Few data exist to guide the application of Mohs micrographic surgery (MMS) in the pediatric population.
Objective:
We sought to summarize the clinical characteristics of children undergoing MMS, identify challenges that limit the use of MMS in this population, and examine how these challenges can be overcome.
Methods:
A systematic review of PubMed and EMBASE, from inception of databases to November 2, 2019, identified all cases of pediatric skin lesions treated with MMS.
Results:
A total of 111 patients were included. The median patient age was 11 years (range 6 weeks to 17 years). The most commonly treated tumor was dermatofibrosarcoma protuberans (n = 62), followed by basal cell carcinoma (n = 30). The most common location was the head and neck (n = 34), followed by the trunk (n = 28) and the extremities (n = 23). The most commonly cited challenges in the application of MMS in children included patient cooperation, concerns for the safety of prolonged general anesthesia, availability of a MMS service in the pediatric setting, and access to a histopathology laboratory experienced in MMS sectioning.
Limitations:
Many articles did not report specific patient characteristics.
Conclusion:
Multiple obstacles limit the application of MMS in pediatric patients. This review describes practical methods to circumvent these obstacles to facilitate the appropriate use of MMS in children.
Insights
Mohs micrographic surgery (MMS) is challenging in children due to cooperation and anesthesia concerns. This review outlines methods to overcome these obstacles for pediatric MMS application.
Area of Science:
- Dermatology
- Pediatric Surgery
Background:
- Limited data guide Mohs micrographic surgery (MMS) application in pediatric patients.
- Understanding challenges is crucial for optimizing MMS in children.
Purpose of the Study:
- Summarize clinical characteristics of pediatric patients undergoing MMS.
- Identify challenges limiting pediatric MMS use.
- Propose methods to overcome these challenges.
Main Methods:
- Systematic review of PubMed and EMBASE databases.
- Included pediatric skin lesions treated with MMS up to November 2, 2019.
Main Results:
- 111 pediatric patients were analyzed; median age was 11 years.
- Dermatofibrosarcoma protuberans and basal cell carcinoma were most common tumors.
- Challenges included patient cooperation, anesthesia safety, service availability, and pathology access.
Conclusions:
- Obstacles to pediatric MMS include patient cooperation, anesthesia, service, and pathology limitations.
- Practical methods are described to facilitate appropriate MMS use in children.
