Factors affecting choice of repair in Mohs micrographic surgery for non-melanoma skin cancer of the head.

BACKGROUND/OBJECTIVES: In Mohs micrographic surgery (MMS) the dermatologist serves as surgeon, pathologist and reconstructive surgeon. Analysis of the factors that play a part in determining defect size and closure type may result in better patient outcomes. The objective was to identify factors contributing to the defect size and closure method employed in MMS.

METHODS

Retrospective analysis of all MMS performed for non-melanoma skin cancers (NMSC) of the head at the Skin and Cancer Foundation Australia, Westmead, between 1 January and 31 December 2007.

RESULTS

Tumor size was the main factor involved in the final defect size (r : 0.60, P < 0.001), but the sex and age of the patient, tumour pathology, site and surgeon were also significantly associated with the final defect size. In a multivariate analysis, only sex did not remain as an independent factor. Regarding closure method, the age of the patient, defect size, site and surgeon were significantly associated, but patient's age did not remain significant in the multivariate analysis.

CONCLUSION

Our study has demonstrated that the performing surgeon is a relevant factor in the determination of defect size and repair methods in MMS. The factors underlying this variability require further study as decisions on closure method should be made objectively, based on patient-related and tumour-related factors. As expected, the location and size of the defect are the other factors that determine the chosen method of repair.