Mohs surgery techniques may cause hyperpigmentation among patients with skin of color

Key takeaways:

• Hyperpigmentation was more common in Fitzpatrick skin types IV to V vs. I to III (48% vs. 18.2%).
• Causes included using grafts and granulation as well as postoperative complications.

Procedural factors influence post-inflammatory hyperpigmentation following Mohs micrographic surgery among patients with skin of color, according to a study.

“[Post-inflammatory hyperpigmentation (PIH)] occurs most noticeably among individuals with skin of color,” Onjona B. Hossain, BS, a student at Albert Einstein College of Medicine, and colleagues wrote. “With the rapidly changing demographic of the United States and rising rates of keratinocyte carcinoma, understanding factors contributing to PIH following Mohs micrographic surgery (MMS) is of particular importance.”

According to the authors, the factors that may contribute to PIH following MMS may either be patient-specific or procedure-specific. In their retrospective study, Hossain and colleagues found that most factors were procedural.

Of 83 cases in 72 individuals with skin of color (81.9% Hispanic; 10.8% Black), grafts and granulation led to a significantly higher rate of PIH vs. layered linear repairs and flaps (87.5% vs. 30.7%; P = .003).
Additionally, cases that encountered a postoperative complication, such as dehiscence, necrosis, hematoma or infection, were associated with a higher rate of PIH vs. cases without complications (81.8% vs. 29.2%; P = .001).

Epidermal closure with staples also had a higher rate of causing PIH compared with epidermal suture materials (75% vs. 29.7%); however, this finding was not significant.

According to a subset analysis of linear repairs, polyglactin 910 as a subcutaneous suture produced a higher rate of PIH vs. poliglecaprone 25 (46.2% vs. 7.1%; P = .015).

As far as patient-specific risk factors, all individuals who developed PIH following MMS were of similar age, sex and immunosuppressed status, but none of these trends were statistically significant. On the other hand, PIH was significantly more common in Fitzpatrick skin types IV to V vs. I to III (48% vs. 18.2%; P = .006).

“This finding is consistent with prior studies and may be due to more active melanocytes resulting in overproduction of melanin and low-grade chronic inflammation in these individuals,” the authors wrote. “When appropriate, surgeons may consider layered linear repairs and flaps to be the preferred reconstructive approach in [skin of color] individuals over grafts and granulation.”