Evaluation of Pain After Mohs Micrographic Surgery: A Prospective Study

Abstract

BACKGROUND Mohs micrographic surgery (MMS) is a widely used technique for removal of cutaneous tumors. The procedure is well-tolerated with little surgical or postoperative pain. OBJECTIVE This study examined pain levels after Mohs surgery throughout the first week of recovery and the relation to patient demographics, lesion characteristics, surgery details, and postoperative analgesia. METHODS A 2-year prospective observational study included patients who underwent MMS. Patients rated the severity of postoperative pain once daily until removal of sutures and documented analgesics used. Analyses of patient and lesion characteristics along with reconstruction methods were conducted. RESULTS A total of 2,178 patients were included in the study. Pain levels were strongest on the first postoperative day (POD) and were significantly different between genders on POD 3. Site of skin lesion, method of reconstruction, and number of stages of MMS were significantly related to postoperative pain levels on univariate and multivariate analyses. Postoperative consumption of analgesics differed significantly between men and women and was not correlated to age. CONCLUSION Mohs surgery is generally nonpainful and is well-tolerated by men and women across all ages. The site of the lesion and method of reconstruction are the major determinants affecting the perception of pain.M ohs micrographic surgery (MMS), first described by F. Mohs in 1938, 1 is a widely used and accepted technique for complete removal of cutaneous tumors under local anesthesia. 2 The use of MMS has increased steadily, and it is estimated that 1 in 4 malignant skin tumors is treated using this technique. 3 The procedure is continued until margins are free of malignant cells and may last even longer depending on the necessary reconstruction; therefore, it is crucial to ensure long-lasting analgesia.In most cases, MMS involves only cutaneous layers and as such is believed to be well-tolerated without much surgical or postoperative pain. Several studies suggest that postoperative pain after nondermatologic surgeries is affected by anxiety. [4][5][6] Relations between pain levels after MMS and patient's gender, as well as tumor size and analgesic consumption have been reported previously. [7][8][9][10] This study examined pain levels after MMS throughout the first week of recovery and their relation to patient demographics, lesion characteristics, surgery details, and postoperative analgesia.

Incidence of Chronic Pain following Oral Soft Tissue Biopsies: A Retrospective Study

“…In our study, 4 patients out of 695 (0.575%), reported chronic pain at the biopsy site 3 months after the procedure (see Table 2 for pain and patient characteristics). All four were women, which is congruent with most other publications that describe a higher rate of post-operative pain in women, e.g., female gender was associated with more severe postoperative pain after root-canal treatment in a cohort of 270 patients [21], and after Mohs Micrographic Surgery [19].…”

“…However, various studies indicate that the Mohs procedure (for treating skin cancer, where individual layers of skin are removed and examined to determine if they are cancerfree) is comparable to oral soft tissue biopsy, because it is generally non-painful and well-tolerated by all genders across all ages [19,20]. In our study, 4 patients out of 695 (0.575%), reported chronic pain at the biopsy site 3 months after the procedure (see Table 2 for pain and patient characteristics).…”

The Mastoid Skin Graft: A Fast, Efficient Donor Site for Auricle Reconstruction After Mohs Surgery

“…As shown in a study by Shir-az et al, 16 pain levels following MMS are strongest in the first postoperative day, but in general MMS is considered nonpainful and well-tolerated. It is common practice in our clinics to educate patients regarding the expected pain levels and to recommend the use of nonopioid based oral analgesics in the days following surgery.…”

Assessment of Pain, Healing Time, and Postoperative Complications in the Healing of Auricular Defects After Secondary Intent Healing Versus Split Thickness Skin Graft Placement

“…However, previous studies have demonstrated increased postoperative pain levels in certain anatomical locations, such as the scalp, forehead, nose, and ear, particularly for the first 3 postoperative days. 8,9 Additionally, the type of reconstruction is known to influence postoperative pain levels, with flaps and grafts, including STSG, resulting in more postoperative pain compared with primary closure. 8,9 In line with these reports, this study found that patients in the STSG group experienced significantly more pain than those in the SIH group during the first 3 days after surgery.…”

“…8,9 Additionally, the type of reconstruction is known to influence postoperative pain levels, with flaps and grafts, including STSG, resulting in more postoperative pain compared with primary closure. 8,9 In line with these reports, this study found that patients in the STSG group experienced significantly more pain than those in the SIH group during the first 3 days after surgery. Nonetheless, the daily mean reflected pain was overall mild to moderate, and well tolerable with over-the-counter analgesics such as acetaminophen.…”