The incidence of major complications from Mohs micrographic surgery performed in office-based and hospital-based settings

Background: There has been significant interest in the safety of office-based surgery. Objective: Our purpose was to compare the safety of Mohs micrographic surgery and related surgical repairs performed in office- and hospital-based settings. Methods: The study included 3937 consecutive patients undergoing Mohs surgery. Surgery was performed at either an outpatient office or a hospital-based setting. Results: Mohs surgery was performed on 1540 patients in the hospital and 2397 patients underwent surgery in the office. The mean patient age was 66 years, and 61% were men. Ninety-three percent of lesions were basal cell or squamous cell carcinomas, and 86% were located on the head and neck. The average tumor measured 1.1 × 1.0 cm, required 1.7 stages of Mohs surgery, and resulted in a defect measuring 2.4 × 1.8 cm. Linear closures, flaps, grafts, and second-intention healing were utilized in 69%, 14%, 6%, and 11% of defects, respectively. There were no differences in patient or tumor characteristics or the types of closures used at the two operating facilities. The only serious surgical complication was gastrointestinal hemorrhage due to naproxen prescribed postoperatively for auricular chondritis in one patient. Conclusion: Mohs micrographic surgery and repair of associated defects can be safely performed in either an office- or hospital-based setting.