Wound care following MMS critical in preventing hyperpigmentation in skin of color

Nonabsorbable sutures or tissue adhesives used in combination with surgical strips and liquid adhesives are safe and effective means to minimizing hyperpigmentation in skin of color following Mohs micrographic surgery, according to a study.

Ramone F. Williams, MD, MPhil, of the department of dermatology at Massachusetts General Hospital and Harvard Medical School, and David Ciocon, MD, of the division of dermatology at Albert Einstein College of Medicine and Montefiore Medical Center, highlighted the increasing diversity of the U.S. population.

“Data show increased utilization of Mohs micrographic surgery (MMS) in people of color,” they wrote.

It was also noted that there are high morbidity and mortality rates associated with skin cancer among individuals with skin of color despite low incidence rates. In addition, data on this subject are lacking.

It was with this in mind that Williams and Ciocon offered some insight into performing the Mohs procedure in skin of color.

One point to consider is the likelihood of postoperative post-inflammatory hyperpigmentation in this patient population. Intraoperative injury, postoperative injury and postoperative inflammation all may contribute to this outcome. Surgeons are encouraged to be particularly careful in manipulating skin of color during and after the procedure to minimize these outcomes.

Similarly, keloids may also be likely in this group. Tissue injury is a key driver of this outcome, along with aberrant wound healing and wound tension.

Suture selection is critical for these patients, according to the authors. Nonabsorbable epidermal sutures with “low reactivity” — including nylon and polypropylene products — are recommended for patients with skin of color. However, the authors cautioned these sutures should be removed promptly to avoid inflammatory suture reaction and related postinflammatory hyperpigmentation.

In addition, using tissue adhesives such as octyl cyanoacrylate with surgical strips and in combination with a liquid adhesive may also have utility with minimal dermatologic outcomes for these patients. The authors advised these adhesives should “flake off on their own” to avoid possible epidermal trauma and postinflammatory hyperpigmentation.

Finally, scar revision is recommended and may be warranted in patients with adverse outcomes after Mohs micrographic surgery.

“Our goal is to better equip dermatologic surgeons for the rapidly changing demographics of our patient population,” the researchers concluded. “We feel this is an important step in addressing the dire health disparities associated with skin cancer in skin of color.”