Bacterial Organisms Colonizing Mohs Surgical Wounds Healing by Second Intention on the Lower Extremities: A Prospective, Controlled Study.

BACKGROUND: Based on recent research, second intention wounds may be at greater risk for postoperative infection compared with sutured wounds. Accurate diagnosis of postoperative wound infections on the lower leg can be challenging and result in unnecessary antibiotic administration. OBJECTIVE: The objective of this study was to identify bacterial organisms that commonly colonize second intention surgical wounds after Mohs micrographic surgery (MMS) and isolate pathogenic organisms. METHODS: Patients with second intention surgical wounds on the lower leg were evaluated 2 weeks after MMS. Wounds were swabbed for bacteria and categorized as infected or not infected based on clinical appearance. Any colonizing bacteria were recorded once the culture results were reported. RESULTS: Twenty-five clinically infected wounds and 26 control wounds were cultured. Staphylococcus aureus was the most common bacteria, colonizing 8 infected wounds (15.7%) and 5 control wounds (9.8%). Eight cultures (32%) from clinically infected wounds grew normal skin flora alone. CONCLUSION: Staphylococcus aureus is the most common bacteria colonizing wounds healing by second intention on the lower extremity. Thirty-two percent of clinically infected wounds grew normal skin flora, demonstrating the challenge of accurately diagnosing infection in lower extremity second intention wounds.

Recurrence Rate for Melanoma Excised by Mohs Micrographic Surgery Without Immunostaining.

BACKGROUND: Mohs micrographic surgery (MMS) is becoming increasingly popular for the treatment of cutaneous melanoma (CM) as multiple studies have demonstrated favorable outcomes for local recurrence and overall survival. OBJECTIVE: To analyze the outcomes of noninvasive (NIM) and invasive melanomas (IM) using MMS with fresh frozen sections. The primary outcome was local recurrence. The secondary outcome was to identify mean surgical margins based on tumor type and location. METHODS: Retrospective cohort study of 224 cases of CM treated from 2006 to 2016 at a tertiary academic center with MMS and fresh frozen sections by a single Mohs surgeon. RESULTS: The overall recurrence rate was 2.6% with a mean follow-up of 36.2 months. The recurrence rate for NIM versus IM was 1.6% and 7%, respectively. The mean margins for NIM and IM were 7.9 mm and 10.1 mm, respectively. These varied by tumor site and location. CONCLUSION: This study supports the use of MMS in the treatment of CM and highlights how narrower surgical margins for NIM of the head and neck can be achieved without increasing risk of local recurrence.

Assessment of Functionality in Elderly Patients When Determining Appropriate Treatment for Nonmelanoma Skin Cancers.

BACKGROUND: The treatment of nonmelanoma skin cancer (NMSC) in the elderly population is a source of significant debate. Mohs micrographic surgery (MMS) is a highly effective treatment option yet not every patient with a cutaneous malignancy that meets appropriate use criteria (AUC) should be treated with surgery. OBJECTIVE: The purpose of this study was to use the Karnofsky Performance Status (KPS) scale to categorize the functional status of patients aged 75 years and older who required treatment of NMSC. The authors wanted to see whether functionality played a role on the treatment selection. METHODS: Patients aged 75 years and older presenting for biopsy of a suspected NMSC that met AUC for MMS were included in the study. Trained medical assistants used the KPS scale to assess patient functionality. Treatment modality was recorded once the biopsy confirmed the NMSC. RESULTS: A cohort of 203 subjects met inclusion criteria for the study. There was a statistically significant difference in utilization of surgical treatments between high and low functionality patients (p = .03). CONCLUSION: Dermatologists consider patient functionality when selecting a treatment for NMSC and use less invasive modalities for patients with poor functional status, even when the tumor meets AUC.