Patients are Willing and Successful With Home Suture Removal After Mohs Surgical Procedures.

BACKGROUND: Suture removal after surgery is low risk; however, it is often performed by a medical provider. The current SARS-CoV-2 pandemic has forced providers to assess means of reducing in-person contact. OBJECTIVE: To determine whether patients undergoing Mohs surgery are willing and successful with home suture removal. MATERIALS AND METHODS: A prospective study was performed with patients undergoing Mohs surgery. Before their surgery, patients were assessed for their willingness to remove sutures before and after viewing educational material. Patients who were willing to attempt removal were contacted after expected suture removal date to verify success and assess their experience. RESULTS: One hundred fifty patients were enrolled in the study. 90.1% were willing to attempt home suture removal. Patients were more willing ( p = .003), more confident ( p = .024), and had lower anxiety ( p = .049) with removal after viewing educational resources. Patients with a history of suture removal were more likely to attempt removal after their procedure ( p = .036). Ninety-seven percent of patients who were willing to attempt suture removal were successful. There were no major complications with removal. CONCLUSION: Patients were overwhelmingly successful with suture removal after an educational intervention. Providers should consider providing this option after surgical procedures when clinically appropriate.

Impact of the COVID-19 Pandemic on Characteristics of Cutaneous Tumors Treated by Mohs Micrographic Surgery.

The COVID-19 pandemic has impacted the practice of Mohs micrographic surgery (MMS). We sought to determine the characteristics of skin cancers treated by MMS during the pandemic compared with prepandemic controls. A retrospective chart review was conducted. Tumors included were all treated in accordance with best practice guidelines set forth by state- and national-level professional governing bodies. Bivariate and multivariate analyses were performed to compare outcome variables. Changes in tumor characteristics during the pandemic are of clinical significance, potentially affecting extent of reconstructive surgery, cost, operating time, and future tumor characteristics.

Impact of the COVID Pandemic on Mohs Micrographic Surgery: A Nationwide Survey.

BACKGROUND: At the onset of the COVID-19 pandemic, many Mohs micrographic surgeries (MMS) were delayed over concerns for propagating further infectious spread and scarcity of medical resources. OBJECTIVE: To assess the impact of the pandemic on MMS and the treatment of skin cancer Methods and Materials: An electronic survey was sent to fellowship trained Mohs surgeons to assess patient outcomes, practice viability, and physician sentiment related to performing MMS during the COVID-19 pandemic. RESULTS: Of the 303 respondents, 82% reported declines in case volume for at least 3 months, and average case difficulty increased for 69% of surgeons following these delays. Instances of local tumor spread following delays were seen by 69% of respondents, and 20% noted cases of regional or systemic metastasis. Only 8 cases of staff testing positive (and 7 cases of patients) were reported, and 97% of respondents felt comfortable performing MMS during the pandemic. Private practice surgeons more often viewed practice restriction recommendations negatively initially (42% vs 26% in academics, P=0.03) and in hindsight (63% vs 36% in academics, P<0.001). CONCLUSIONS: Mohs surgeon’s ability to minimize spread of COVID-19 during routine patient care, alongside potential risks of delaying treatment of skin cancers, should be considered in future recommendations for patient care. J Drugs Dermatol. 2022;21(5):545-547. doi:10.36849/JDD.6189.

Pilot Survey of Adoption of Telemedicine in Mohs Surgery During the COVID-19 Pandemic.

BACKGROUND: The Covid-19 Pandemic prompted the widespread implementation of telemedicine across healthcare. OBJECTIVE: To analyze telemedicine adoption by Mohs Micrographic surgeons (MMS) during the COVID-19 pandemic; to analyze the attitudes and perceived barriers to its long-term continuation by MMS practices. METHODS AND MATERIALS: An online multiple-choice survey was distributed to members of the American College of Mohs Surgeons. RESULTS: 86.1% of surveyed Mohs surgeons initiated telemedicine during the pandemic surge. The most common uses for telemedicine amongst respondents were post-surgery management (77.4%), "spot checks" (60.9%), and surgical consultations (59.1%). 73.1% report patients were receptive to telemedicine. 68.6% believe that telemedicine has a place in dermatologic surgery; 49.5% plan to incorporate telemedicine into their surgical practices long-term. Physical exam limitations, fitting telemedicine into practice workflow, and patient reception/patient training were viewed as the most significant barriers to long-term implementation. CONCLUSIONS: While valuable use cases for telemedicine were identified with most Mohs surgeon respondents feeling that telemedicine has a place in their practices, there is uncertainty in how to implement telemedicine into the dermatologic surgery practice workflow.

Evaluation of Public Interest in Mohs Surgery and Other Elective Surgical Procedures During the COVID-19 Pandemic.

BACKGROUND: The reallocation of health care resources to focus on the acute care needs of COVID-19 patients leads to a delay and deferral of outpatient surgical procedures such as Mohs surgery. OBJECTIVE: Planning for the resumption of regular outpatient surgical care and preparing for future surges in COVID-19 cases requires identifying surrogate markers of health care demand. MATERIALS AND METHODS: United States national and state-based Google search data for "Mohs surgery" and other common elective surgical and cosmetic procedures were evaluated. These were compared with national and state-wide COVID-19 case number and death data from the Johns Hopkins University. Pearson correlation coefficients were generated to assess the association between COVID-19 cases and deaths with Google search trends. RESULTS: Search volume for "Mohs surgery" and other elective surgical and cosmetic procedures significantly decreased as the number of new deaths from COVID-19 increased. Statistically significant inverse correlation was noted between "Mohs surgery" search volume and new COVID-19 deaths on a national and state-based level. CONCLUSION: Search metric analysis may be used as part of a big data model to help predict health care demand during the reopening phase of the COVID-19 pandemic.

Urgent safety considerations for dermatologic surgeons in the COVID-19 pandemic.

Dermatologic surgeons are at increased risk of contracting SARS-COV-2. At time of writing, there is no published standard for the role of pre-operative testing or the use of smoke evacuators, and personal protective equipment (PPE) in dermatologic surgery. Risks and safety measures in otolaryngology, plastic surgery, and ophthalmology are discussed. In Mohs surgery, cases involving nasal or oral mucosa are highest risk for SARS-COV-2 transmission; pre-operative testing and N95 masks should be urgently prioritized for these cases. Other key safety recommendations include strict control of patient droplets and expanded pre-clinic screening. Dermatologic surgeons are encouraged to advocate for appropriate pre-operative tests, smoke evacuators, and PPE. Future directions would include national consensus guidelines with continued refinement of safety protocols.