A prospective evaluation of the incidence of complications associated with Mohs micrographic surgery

Background: Because outpatient surgery is being increasingly scrutinized in the lay press, it is important that dermatologists and dermatologic surgeons accurately characterize the safety of office-based surgery. Although there is abundant anecdotal evidence to support the inherent safety of dermatologic surgery, there are few data that support the safety of Mobs micrographic surgery (MMS) as performed by appropriately trained dermatologic surgeons in outpatient settings. Design: All patients presenting for MMS micrographic surgery during the calendar year 2000 were prospectively enrolled in this study designed to evaluate the incidence of multiple complications associated with scalpel-based cutaneous surgery (postoperative hemorrhage, hematoma formation, wound infection, wound dehiscence, and flap/graft necrosis). Setting: An academic MMS practice. Patients: A total of 1052 patients (1358 MMS cases) were prospectively enrolled. Complete follow-up information was available for 1343 cases (98.9%). Results: Complications associated with MMS were very infrequent, with an overall complication incidence of 1.64% (22/1343). Most surgical complications involved difficulties with hemostasis. No complications were significant enough to involve the assistance of another specialist or to require the hospitalization of the patient. Conclusions: Mohs micrographic surgery is a very safe outpatient procedure when performed by appropriately trained physicians. The types of complications seen in our patients were identical to those seen in hospitalized patients described in previous studies. Our complication rates were equal to or lower than the published complication rates from specialists in other surgical disciplines.