News: Mohs Surgery Even Safer Than Previously Known

NEW YORK (Reuters Health) Oct 10 - Mohs micrographic surgery (MMS) is extremely safe, even for patients who might be considered poor candidates for surgery, according to the largest prospective study to date of the dermatologic procedure.

The 23-center study included nearly 21,000 MMS procedures and found 149 adverse events, including just four serious ones.

"Mohs micrographic surgery is exceedingly safe pretty much regardless of where it's done, by whom it's done, as long as it's done by a qualified provider," Dr. Murad Alam of the Feinberg School of Medicine at Northwestern University in Chicago, the study's lead author, told Reuters Health. "The adverse event rate including minor adverse events is far less even than the one percent that's in the literature."

In MMS, a surgeon removes skin cancer layer by layer, examining each layer under a microscope, until only cancer-free tissue remains. While MMS is considered to be safe, most data on complications has either been anecdotal, focused on a single center, or has addressed only one kind of adverse event, Dr. Alam and his colleagues wrote in JAMA Dermatology, in a paper online September 30.
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For the present analysis, the investigators gathered data from 21 private ambulatory referral centers and two institutional centers using DermBase, a Web-based collaborative research tool. Each center gathered data on consecutive MMS patients for eight months, and start dates were staggered across an eight-month period.

The most common adverse events were infections (83 patients), impaired wound healing (30 patients), and bleeding or hematoma (22 patients). Four patients had infection-related complications requiring hospitalization, while one patient had a motor nerve injury.

Many patients with skin cancer are elderly, with significant comorbidities, Dr. Alam noted. Because MMS is performed under local anesthesia on an outpatient basis, he added, it's "well tolerated in patients who otherwise might be considered fragile candidates for surgery."


JAMA Dermatol 2013.