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Surgical site uncertainty found in Mohs’ micrographic surgery patients

Dermatology patients who struggle to identify their biopsy sites before Mohs’ micrographic surgery are at risk for wrong-side surgery, according to recent study results.

Researchers evaluated 329 patients with 333 skin cancer sites who sought Mohs’ micrographic surgery between April 1, 2009 and Feb. 9, 2010. Study participants (mean age 69 years) were asked to identify their biopsy sites before and then on the day of their surgeries. When once-visible lesions were no longer identifiable to patients, they had to return to their referring physicians to reconfirmation their biopsy locations. On the day of their surgeries, participants again were asked to identify their surgical sites, and 9% were unable to confidently identify them.

In 88.5% of cases, the lesions were located on patients’ heads and necks. There was a statistically significant difference between the patients who were able to identify their surgical site and those who were not (P=.035) for the skin cancers located where patients could see them. Patients who were able to see their biopsy sites were 3.5 times more likely to identify their surgical sites.

Researchers noted that 47.6% of patients had accompanying chart notes, with 5% of them having photographs and 23% of them having high-quality diagrams of their lesions’ locations. Longer periods of time between the biopsy and surgery date also made identification more difficult, although those who delayed surgeries more than 3 months after biopsies and could not identify lesions vs. those who could was considered statistically insignificant (P=.37).

“This prospective study has demonstrated that there is a significant risk of performing wrong-site procedures in dermatologic study,” the researchers concluded. “Skin cancers located in areas not visible to the patient increase the risk of wrong-site surgery. … To minimize this risk, dermatologists must take a proactive role to improve our medical records with better prebiopsy site documentation and photography.”