ORLANDO – Patients with a history of immunosuppression who then undergo Mohs Micrographic Surgery to remove cancerous growths on the face or neck are more likely to experience complications from the surgery than patients without immune system problems, researchers reported here.
In a retrospective study that included data from more than 4,000 patients who underwent Mohs surgery for non-melanoma skin cancer, a history of immunosuppression was associated with a 9.694 times the odds of having a post-operative complication (P=0.003), said Pallavi Basu, BA, a medical student at the University of California, San Diego.
In her poster presentation at the annual meeting of the American Academy of Dermatology, Basu noted that solid organ transplant patients had 8.824 times the odds of having a post-operative complication when compared with immunocompetent patients having the same type of surgery (P=0.006).
"Most of these complications are infections," Basu told 鶹ý at her oral poster discussion.
However, the research team found that patients who have hematological malignancies and those patients under treatment for human immunodeficiency virus (HIV) infection did not appear to be at any greater risk for complications after Mohs surgery than immunocompetent individuals.
Basu said that among the patients who had solid organ transplants, those recipients who had a heart transplant experienced a 7.89 times the odds of a post surgery complication when compared with patients without histories of immunosuppression (P=0.019). Kidney, liver, and lung transplants were not associated with statistically significant increased risk of complications.
"Immunosuppressed patients are not only at risk for multiple, aggressive non-melanoma skins cancers," she said, "but may be at an increased risk for overall post-operative complication following Mohs Micrographic Surgery."
Basu also reported that use of immunosuppressive therapy was also associated with complications, increasing the rate to 5.775 times the odds of a complication compared with immunocompetent individuals (P=0.021). The use of sirolimus as one of those immunosuppressive agents was associated with a risk 18 times that of the immunocompetent patients (P<0.001), and the use of tacrolimus was associated with 9 times rate of complications (P=0.007). Cyclosporin was not associated with a statistically significant increase in risk of complications.
The researchers also noted that alcohol use was associated with a 6.8 times the odds of a complication compared with immunocompetent individuals.
Basu noted that the patients who had complications tended to be older, with a mean age of 70.7 years compared with 67.8 years for patients who did not have post-operative complications (P=0.005).
In commenting on the study, , a dermatologist at Lenox Hill Hospital, New York, and a member of the board of directors of the American Society for Dermatologic Surgery, told 鶹ý, "Mohs Micrographic Surgery is the standard of care for certain malignancies, especially on the face, in order to reduce the need for multiple procedures, scar size, and recurrence of skin cancer at the site.
"For those who are immunocompromised from specific disease or from immunosuppression due to organ transplant, the risk of peri-operative complication is expected to be higher than the general population.
"By understanding the distinctions between groups of immunocompromised patients we better understand that not all forms of immunocompromisation are the same and the level of risk can vary. Further study can help offer details of pre- and post-op preparation to minimize risks as appropriate for those at highest risk of post-operative complications," she said.
Disclosures
Basu and Day disclosed no relevant relationships with industry.
Primary Source
American Academy of Dermatology, 75th annual meeting
Basu P et al, "A four-year retrospective assessment of post-operative complications associated with Mohs Micrographic Surgery in immunosuppressed patients," AAD2017.