Mohs Micrographic Surgery: Anticoagulants and Hemostatic Agents Impact

Mohs micrographic surgery (MMS) is a specialized dermatological surgical technique frequently employed when treating non-melanoma skin cancers. MMS is considered a safe surgical procedure with a low overall risk of perioperative complications. A minor amount of intraoperative bleeding is expected during MMS; such bleeding is easily controlled with a combination of electrocautery, gentle mechanical pressure, or topical hemostatic agents. However, rare occurrences of more severe perioperative bleeding may lead to hematoma formation, wound dehiscence, and potential loss of grafts or flaps. Patients undergoing MMS during the concomitant use of antiplatelet or anticoagulant therapy are at increased risk of perioperative bleeding and subsequent complications. Direct-acting oral agent (DOAC) anticoagulant therapy is increasing in frequency and may pose additional perioperative bleeding risks.  A comprehensive understanding of the risks associated with antiplatelet and anticoagulant medications, partnered with diligent perioperative management and meticulous attention to intraoperative hemostasis, is necessary to reduce complications in patients undergoing MMS during concomitant anticoagulation therapy. This activity will review the current recommendations for the perioperative management of these patients, including the risks, benefits, and technical considerations.