Mohs Micrographic Surgery in Skin of Color

Abstract

The United States population is becoming increasingly diverse. Data show increased utilization of Mohs micrographic surgery (MMS) in people of color. Though the incidence of skin cancer in skin of color is low, morbidity and mortality are disproportionately high. Still, published literature on the topic is lacking. In this article, we outline our approach to MMS in skin of color. We review salient topics not published elsewhere in literature in this context, including post-operative postinflammatory hyperpigmentation and suture selection in skin of color. Our goal is to better equip dermatologic surgeons for the rapidly changing demographics of our patient population. We feel this is an important step in addressing the dire health disparities associated with skin cancer in skin of color.

Suture Selection to Minimize Postoperative Postinflammatory Hyperpigmentation in Patients With Skin of Color During Mohs Micrographic Surgery

“…We used a simple running suture with 4-0 nylon to close the surgical wound. We avoided fast-absorbing gut sutures because they have high tissue reactivity 1,4 ; use of sutures with low tissue reactivity, such as nylon and polypropylene, decreases the risk for inflammation without compromising alignment of wound edges and overall cosmesis of the repair. Prolene also is cost-effective and presents a decreased risk for wound dehiscence.…”

“…Despite these benefits, research suggests that natural absorbable gut sutures induce cutaneous inflammation and should be avoided in patients with skin of color. 1,3,4 Nonabsorbable sutures are less reactive, reducing PIH after MMS in patients with skin of color.…”

Two Cases of Pigmented Basal Cell Carcinoma in African American Patients

“…The incidence of skin cancer among non-Hispanic White individuals is almost 30 times higher than that among non-Hispanic Black or Asian/Pacific Islander individuals [4]. However, morbidity and mortality are disproportionately higher in minority groups, as these malignancies are often diagnosed in later stages, where they may become more difficult to treat and tend to behave more aggressively [7,8]. This presents a diagnostic challenge for those caring for patients with skin of color.…”

Efficacy and Safety of Intralesional Tranexamic Acid Injections in the Treatment of Postoperative Scars: A Split-Scar Comparative Study

“…Thus, some degree of erythema and PIH may be inevitable. 1 The latter is especially noted in patients with dark phototypes in the setting of labile and reactive melanocytes. UV and visible light are important contributors to PIH.…”

“…Recently, tranexamic acid (TA), an antifibrinolytic medication, was used for the treatment of facial erythema and hyperpigmentation. 1 In this study, we aimed to evaluate the efficacy and safety of intralesional injections of TA in the treatment of hyperpigmented and/or erythematous postoperative scars.…”