Perioperative management of dermatologic surgery patients on systemic cancer therapy

The rapid expansion of immunotherapy and targeted oncologic treatments leading to improved overall survival has led to a growing number of patients requiring dermatologic surgery for skin cancer while receiving systemic cancer therapy. However, perioperative management in this setting remains poorly defined. Dermatologic surgeons and oncologists must balance risks of impaired wound healing, bleeding, and infection against potential consequences of skin cancer progression versus treatment interruption, underscoring the need for multidisciplinary guidance. Here, we review perioperative management strategies at a tertiary cancer center and integrate FDA prescribing information, published data, and expert recommendations developed through multidisciplinary meetings between Mohs surgeons and medical oncologists. Our recommendations address key therapeutic classes including targeted therapies, cytotoxic chemotherapies, immunomodulators, proteosome inhibitors, and antibody drug conjugates, each of which presents distinct considerations. Across therapies, optimal management centers on individualized decision-making, preoperative laboratory assessment, careful timing of drug interruption for agents with known wound-healing or hematologic effects, and close postoperative monitoring. As systemic therapies continue to evolve, these expert-based recommendations aim to support safe, personalized perioperative care for the increasing population of oncology patients undergoing dermatologic surgery.