Transplant Patients Suffer More Mohs Surgery Infections

Patients with a history of immunosuppression (IS) who undergo Mohs micrographic surgery (MMS) are more likely to experience post-surgical complications, according to a new study.

Researchers at the University of California, San Diego conducted a cross-sectional retrospective study that included data involving 4,151 patients who underwent MMS for non-melanoma skin cancer (NMSC); of these, 693 patients were defined as IS, including patients who were solid organ transplant recipients (SOTR), patients on chronic immunosuppressive therapy, or patients who had a diagnosis of leukemia, lymphoma, or HIV. Complication was defined as any adverse event reported within two weeks of MMS, directly related to the procedure.

The result showed that overall IS status was associated with a 9.6 times odds of complication. Among subtypes, SOTR had 8.824 times the odds of complication, while hematologic malignancy or HIV-positive status did not predict significantly higher odds. IS therapy was associated with 5.775 times the odds of complication, with the macrolides sirolimus and tacrolimus displaying 18 and 9 times higher odds, respectively. The study was presented as a poster session at the annual meeting of the American Academy of Dermatology, held during March 2017 in Orlando (FL, USA).

“IS patients are not only at higher risk for multiple, aggressive NMSCs, but may be at increased risk for overall post-operative complication following MMS,” concluded lead author UCSD medical student Pallavi Basu, BA, and colleagues. “In particular, heart transplant recipients or patients on sirolimus or tacrolimus may benefit from post-procedure infection prophylaxis, as well as careful management and repair to avoid necrosis or hematoma.”

MMS is the treatment of choice for basal cell and squamous cell carcinomas at high risk for local recurrence. The technique involves removal of the cutaneous carcinomas using precise microscopic marginal control with the aid of horizontal frozen sections. Advantages include superior cure rates, maximal tissue conservation, the ability to trace perineural or infiltrating tumors histologically, overall lower costs relative to that of radiation therapy, excision, or surgery, and negligible risk of complications from general anesthesia.