Engineered Skin Substitutes in Dermatologic Surgery: A Systematic Review

Area of Science:

• Dermatology
• Surgical Oncology
• Regenerative Medicine

Background:

• Artificial skin substitutes offer a flexible alternative to autografting in Mohs micrographic surgery (MMS).
• The clinical characteristics and outcomes of skin substitutes in MMS are not well-defined.
• This study aims to summarize existing clinical data on skin substitutes used in MMS for cutaneous malignancy.

Purpose of the Study:

• To systematically review and synthesize clinical data on the use of artificial skin substitutes in Mohs micrographic surgery (MMS).
• To evaluate the outcomes and complications associated with different types of skin substitutes in treating cutaneous malignancies.

Main Methods:

• A comprehensive literature search was performed across MEDLINE, Embase, and Web of Science.
• Included studies reported original data on outcomes following skin substitute use in MMS for cutaneous malignancy.
• Data synthesis involved weighted averages, and bias was assessed using the Oxford CEBM Levels of Evidence.

Main Results:

• Out of 1,007 articles, 40 met the inclusion criteria, encompassing 898 patients.
• Xenografts were the most frequently used type of skin substitute.
• Overall outcomes were excellent across all skin substitutes, with minor, correctable complications reported in a small patient subset. Semi-synthetic and xenografts demonstrated affordability.

Conclusions:

• Artificial skin substitutes are highly effective and demonstrate significant potential in Mohs micrographic surgery.
• Current evidence primarily stems from small, retrospective studies, highlighting a need for comparative and prospective research.
• Further investigation is recommended to compare different skin substitutes and establish their efficacy against controls.