Abstract
This article determines if patient, defect, and repair factors can be used to predict
the use of additional treatments to achieve optimal aesthetic results after repair
of facial Mohs defects. An electronic chart review of patients undergoing Mohs excision
and reconstruction of facial neoplasms from November 2005 to April 2017 was performed,
reviewing patient demographics and history, tumor size, defect size and location,
method and service of reconstruction, time between resection and repair, complications,
and subsequent treatments. A total of 1,500 cases with basal cell and squamous cell
carcinoma were analyzed. The average defect size was 3.09 ± 8.06 cm2; 81.9% of defects were less than 4 cm2 in size. Advancement flaps were used to repair 44.3% of defects. Complications and
undesired sequelae (CUS) were noted in 15.9% of cases; scar hypertrophy or keloid
(10.8%) was most common. Postoperative ancillary procedures were performed in less
than one-quarter (23.4%) of patients to enhance the postrepair appearance; the most
common procedures were intralesional corticosteroid injections and pulse dye laser
treatments. CUS were more likely in females (19.6%), defects on the lips (28.7%) and
on the nose (27.3%) (p < 0.001 for each). Females (22.7% vs. 12.7%), lip repairs (40.2% vs. 18.3%), transposition
flaps (39.2% vs. 14.8%), and repairs performed by a dermatologist (17.9% vs. 11.2%)
(p < 0.001 for each) were more likely to be treated with postoperative corticosteroid
injections. Females (14.5% vs. 7.4%), patients under the age of 60 years (13.9% vs.
8.8%), and patients whose repair was performed by a dermatologist (11.9% vs. 2.9%)
(p < 0.001 for each) were more likely to receive postoperative pulsed dye laser treatments.
CUS and ancillary procedures after repair of facial Mohs defects are uncommon. Awareness
of individual risk factors and defect characteristics allows the surgeon to choose
the most appropriate repair technique while anticipating the potential need for ancillary
procedures.
Keywords
Mohs Defect - ancillary procedures - complications - scar revision - pulse dye laser
