Outpatient Superficial Bone Decortication After Mohs Micrographic Surgery or Excisional Surgery for Cutaneous...

When performing Mohs micrographic and dermatologic surgery for high-risk cutaneous malignancies, particularly aggressive scalp tumors, there may be positive or indeterminate deep margins overlying clinically uninvolved bony cortex (outer table).

To ensure complete tumor extirpation in these situations, the authors performed superficial bone decortication and report their case series.

Over six consecutive months, superficial bone decortication was performed using a microdrill with rosehead bur after 10 Mohs micrographic surgery cases and one incomplete skin cancer excision. Cases included eight squamous cell carcinomas, two pleomorphic dermal sarcomas, and one basal cell carcinoma. The mean preoperative largest tumor diameter was 37.2 mm, and the mean postoperative largest defect diameter was 49.4 mm. Patients completed mixed-methods questionnaire with a Likert scale, dichotomous, and open-questions.

The median pain value was 0 (mean 0.4) during the decortication surgery. All patients receiving Mohs surgery preferred superficial bone decortication under local anesthetic on the day of Mohs rather than referral for another day under general anesthetic.Analysis of open questions determined the procedure was similar to dental drilling -noisy with a vibratory sensation but caused little discomfort.

Superficial bone decortication is a well-tolerated and safe procedure in an outpatient setting and can be readily performed after Mohs micrographic surgery in clinically uninvolved bone.