Cohort study on the Effect of various nicotine consumption modalities on Mohs surgery complications

Knowledge on the effect of different nicotine consumption modalities on dermatologic surgical outcomes is limited, with conflicting conclusions. Cigarette smoking is known to adversely affect outcomes, but the impact of other nicotine consumption modalities like cigars, smokeless tobacco, and nicotine replacement therapy (NRT) is less understood. Our objective was to evaluate the impact of various nicotine consumption modalities on complication rates after Mohs micrographic surgery (MMS). We conducted a prospective cohort study of 404 MMS patients. Variables analyzed included patient age, sex, post-operative complications, and nicotine history via a questionnaire. We found that patients with any history of nicotine use had an 8.5% absolute risk of experiencing complications while the risk for patients without a history of nicotine use was 3.1%, representing a relative risk of 2.75. Cox proportional hazard testing found patient sex and past smoked tobacco use as statistically significant factors for complications. Patients who have smoked tobacco appear to be at a significantly increased risk of experiencing a complication following MMS compared to never-nicotine users. Larger studies are needed to clarify the surgical risks posed by smokeless nicotine products.