Assessment of postoperative pain after Mohs micrographic surgery.

BACKGROUND: Mohs micrographic surgery (MMS) has the highest cure rate for the treatment of cutaneous malignancies and is usually performed in an outpatient setting with local anesthesia. Although most patients experience minimal discomfort during the procedure, postoperative pain after MMS has not been well-characterized. The objective of this study was to evaluate the amount of postoperative pain after MMS and to determine whether the degree of pain is correlated with factors such as tumor location, size, number of excisions, or age or sex of the patient. MATERIAL AND METHODS: One hundred fifty-eight patients with skin cancer treated with MMS were included in this study. Information recorded for each study participant included age, sex, diagnosis, tumor location, number of sites, number of Mohs excision stages, and type of repair performed. A daily log was given to patients to record the amount of pain experienced using the Wong-Baker pain scale and any analgesics that were taken for the 8 consecutive days beginning on the day of surgery. RESULTS: The majority of patients reported some degree of pain on day 0 (mean pain score 1.97 ± 1.46) and day 1 (mean pain score 1.15 ± 1.20); the fraction of patients reporting pain and the severity of that pain diminished steadily thereafter. By day 7, only 25 patients (16%) were experiencing any pain (average pain score 0.21). Only 26 patients (16%) required prescription analgesics on the day of surgery (day 0) and fewer on subsequent days. Seventy-seven of the patients used acetaminophen on day 0 (55%), which rapidly declined each subsequent day. Greater reported pain was significant for scalp procedures and multiple same-day procedures. No significant differences in pain scores were noted with regard to age or sex. CONCLUSION: Postoperative pain after MMS was associated with only mild to moderate pain on the day of surgery and the first postoperative day. Most pain was effectively managed using oral acetaminophen, with a minority of patients requiring prescription analgesics. Surgery on the scalp was significantly more painful than on other sites. Patients can be reassured that MMS and reconstruction is well-tolerated and associated with only mild to moderate discomfort postoperatively.

The biomechanical properties of the skin.

BACKGROUND: The skin possesses unique biochemical properties that allow it to protect and conform to the body that it covers. Elements constituting the dermis-collagen and elastin-primarily afford these properties. OBJECTIVES: To define these properties and explore their relevance with regard to aging skin and dermatologic surgery. MATERIALS AND METHODS: In the first part of this review, the determinants of mechanical properties of the skin will be outlined, through an extensive review of the literature. General physical properties that explain the behavior of skin will be defined, and diseases that manifest the extremes of those properties will be discussed. In the second half of this discussion, the surgical implications of skin biomechanics will be reviewed. RESULTS: Emphasis will be placed on understanding how dermatologic surgeons may optimally use skin properties to produce the best cosmetic and functional outcomes possible. CONCLUSION: Understanding of the biomechanical properties of skin is paramount to obtain the best cosmetic outcomes in dermatologic surgery.