Plastic and reconstructive Mohs Surgery

Published Date: 19th July 2016

Publication Authors: Wain R, Tehrani H

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Comparisons between Mohs micrographic surgery (MMS) and conventional excision (CE) have been made in the past, in particular relating to tumour recurrence rates; however, there are no comparative studies of reconstructive outcomes between these two methods in the current literature. We compared the reconstructive techniques and histological findings of our patient group to evaluate the effectiveness of plastic and reconstructive MMS vs. CE and reconstruction. All patients listed for MMS in our service between January 2013 and January 2014 were included. Preoperative patients were prospectively assessed for the margins and type of reconstruction that would be necessary if CE were utilized. Post-MMS, the extent of complete excision and reconstructive method used were recorded and compared with the preoperative non-MMS plan. In total 157 patients were analysed over 13 months, with a mean age of 63 4 years and a male-to-female ratio of 1 : 1 5. The anatomical distribution of the lesions was consistent with the current literature and included 93% basal cell carcinoma, 6% squamous cell carcinoma and 1% microcystic adnexal carcinoma (MAC). Had CE and reconstruction been used, 47% of patients would have received a more invasive or cosmetically less desirable reconstruction, and 24% of margins would remain incomplete. The outcome was unchanged in 20% of patients. A small but significant proportion (9%) of patients would have lost fundamental structures, for example orbital exenteration, or undergone reconstructions unnecessarily crossing aesthetic subunits. This supports existing evidence that MMS permits optimum tissue preservation while virtually guaranteeing complete excision. While in its infancy, plastic and reconstructive MMS offers a valuable service with a demonstrable benefit seen in 80% of patients undergoing MMS in our unit. Additionally, comparison of MMS and CE provides a method for evaluating the efficiency and effectiveness of the service. A high percentage of patients demonstrating no gain in outcomes over CE may indicate inefficient usage of the MMS service and may be a useful method for other MMS centres to ensure they provide a cost-effective service in a constrained financial climate.

Wain, R; Tehrani, H. (2014).  Plastic and reconstructive Mohs surgery enhances outcomes compared with conventional excision and reconstruction . British Journal of Dermatology. 171 (Supplement S4), 59.

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