Mohs micrographic surgery (MMS) for non-melanoma skin cancer is often quoted as having an excellent safety profile.
(1) Determine the complication rate of patients undergoing MMS in a large UK Mohs unit and subdivide complication rates into mild/intermediate and major and (2) Identify potential risk factors necessitating a clinical intervention.
This is a single centre cross sectional study of 1000 MMS cases performed with in-house repair. Notes from the post-surgical dressing clinics were reviewed at Visit-1 (day 7-14) and Visit-2 (approximately week 6). Based upon the intervention required and effect on cosmetic/functional outcome, complications were classified as minor, intermediate or major. Logistic regression modelling was used to identify risk factors associated with a complication that needed a clinical intervention (i.e. intermediate or major).
1000 MMS cases were performed on 803 patients resulting in 1067 excisions. Complication rates in our cohort were minor=3.6%, intermediate=3.1% and major=0.8%. Potential risk factors for developing a complication included patients undergoing a graft [unadjusted OR 4.89 (95% CI 1.93,12.39), fully adjusted OR 7.13 (95% CI 2.26,22.45)] and patients undergoing surgery on their forehead [unadjusted OR 3.32 (95% CI 0.95,11.58), fully adjusted OR 5.34 (95% CI 1.40,20.42)]. Patients whose wounds were allowed to heal by secondary intention healing exhibited no complication (6.8%) CONCLUSION: We advocate that patients should be consented that ‘less than one in every hundred patients (0.75%) undergoing MMS will have a serious adverse event (major complication) affecting their cosmetic or functional outcome’.

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