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Cited by 207Nonmelanoma Skin Cancer StudiesCutaneous Melanoma Detection and ManagementDermatologic Treatments and Research

Adverse Events Associated With Mohs Micrographic Surgery: Multicenter Prospective Cohort Study of 20 821 Cases at 23 Centers

Alam, Murad, Ibrahim, Omer, Nodzenski, Michael, Strasswimmer, John M., Jiang, Shang I. Brian, Cohen, Joel L., Albano, Brian J., Batra, Priya +42 more·2013·JAMA Dermatology
DOI 10.1001/jamadermatol.2013.6255
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Abstract

IMPORTANCE: Detailed information regarding perioperative risk and adverse events associated with Mohs micrographic surgery (MMS) can guide clinical management. Much of the data regarding complications of MMS are anecdotal or report findings from single centers or single events. OBJECTIVES: To quantify adverse events associated with MMS and detect differences relevant to safety. DESIGN, SETTING, AND PARTICIPANTS: Multicenter prospective inception cohort study of 21 private and 2 institutional US ambulatory referral centers for MMS. Participants were a consecutive sample of patients presenting with MMS for 35 weeks at each center, with staggered start times. EXPOSURE: Mohs micrographic surgery. MAIN OUTCOMES AND MEASURES Intraoperative and postoperative minor and serious adverse events. RESULTS: Among 20 821 MMS procedures, 149 adverse events (0.72%), including 4 serious events (0.02%), and no deaths were reported. Common adverse events reported were infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events. CONCLUSIONS AND RELEVANCE: Mohs micrographic surgery is safe, with a very low rate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate. Common complications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely during MMS. We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changes would be cost-effective given the small risk reductions.

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  • The performance of the procedures with local anesthesia and vasoconstrictors (100 cases) in the outpatient setting (95 cases) did not show an increase in risks or complications for the patients.

    “The performance of the procedures with local anesthesia and vasoconstrictors (100 cases) in the outpatient setting (95 cases) did not show an increase in risks or complications for the patients, data that have been well established in the literature.17, 18, 19, 20, 21”

    From Auricular reconstruction after Mohs micrographic surgery: analysis of 101 cases (2021) · cites this paper as [19]

  • With 0.99% infection and 6.93% minor complications (bleeding and partial graft necrosis), the authors' sample reproduces the types of adversities most often described in the literature.

    “With 0.99% of infection and 6.93% of minor complications (bleeding and partial graft necrosis), the authors’ sample reproduces the types of adversities most often described in the literature.10, 19”

    From Auricular reconstruction after Mohs micrographic surgery: analysis of 101 cases (2021) · cites this paper as [19]

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Authors
Alam, M., Ibrahim, O., Nodzenski, M., Strasswimmer, J. M., Jiang, S. I. B., Cohen, J. L., Albano, B. J., Batra, P., Behshad, R., Benedetto, A. V., Chan, C. S., Chilukuri, S., Crocker, C., Crystal, H. W., Dhir, A., Faulconer, V. A., Goldberg, L. H., Goodman, C., Greenbaum, S. S., Hale, E. K., Hanke, C. W., Hruza, G. J., Jacobson, L., Jones, J., Kimyai-Asadi, A., Kouba, D., Lahti, J., Macias, K., Miller, S. J., Monk, E., Nguyen, T. H., Oganesyan, G., Pennie, M., Pontius, K., Posten, W., Reichel, J. L., Rohrer, T. E., Rooney, J. A., Tran, H. T., Poon, E., Bolotin, D., Dubina, M., Pace, N., Kim, N., Disphanurat, W., Kathawalla, U., Kakar, R., West, D. P., Veledar, E., & Yoo, S.
Affiliations
  • Northwestern University (US)
  • Cleveland Clinic (US)
  • University of California San Diego (US)
  • University of Pennsylvania (US)
  • Memorial Hermann (US)
  • DermSurgery Associates (US)
  • Austin Diagnostic Clinic (US)
  • Thomas Jefferson University (US)
  • Laser and Skin Surgery Center of New York (US)
  • Laser and Skin Surgery Center of Indiana (US)
  • Saint Louis University (US)
  • The University of Texas MD Anderson Cancer Center (US)
  • University of Florida Health (US)
  • Brown University (US)
  • University of Chicago (US)
  • Thammasat University (TH)
  • Emory University (US)
ORCID
Venue
JAMA Dermatology
Publisher
American Medical Association (AMA)
Published
2013-12-01
Volume
149
Issue
12
Pages
1378
ISSN
2168-6068 (ISSN-L)
DOI
10.1001/jamadermatol.2013.6255
OpenAlex
W2062163093
Cited by
207
References
17
Citations by year
2026: 20 · 2025: 24 · 2024: 19 · 2023: 13 · 2022: 17 · 2021: 23 · 2020: 13 · 2019: 30 · 2018: 13 · 2017: 11 · 2016: 11 · 2015: 8 · 2014: 3
FWCI
5.34
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA Dermatology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • American Academy of Dermatology
  • Northwestern University
  • LEO Pharma
  • Allergan
Topics
  • Health Sciences › Medicine › Epidemiology › Nonmelanoma Skin Cancer Studies
  • Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
  • Health Sciences › Medicine › Dermatology › Dermatologic Treatments and Research
Keywords
Mohs micrographic surgery, surgical complications, adverse events, wound healing, surgical site infection, wound dehiscence, wound necrosis, postoperative bleeding, hematoma, anticoagulation, antiseptics, antibiotics, sterile gloves, skin cancer surgery, surgical safety
MeSH terms
Aged, Aged, 80 and over, Anti-Infective Agents, Local, Anti-Bacterial Agents, Anticoagulants, Female, Gloves, Surgical, Humans, Male, Prospective Studies, Skin Neoplasms, Surgical Wound Infection, United States, Wound Healing, Cohort Studies, Mohs Surgery, Blood Loss, Surgical

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