BACKGROUND: Skin cancer is the most common malignant neoplasm, with more than 5.4 million cases diagnosed annually in the United States. Treatment varies based on the type of neoplasm, its location, as well as primary vs. recurrent lesions. Nonetheless, surgical treatment remains the gold standard. Mohs micrographic surgery (MMS) is a commonly used surgical technique in the excision of such neoplasms. The technique of MMS allows for the precise removal of skin cancers while offering the highest cure rates with maximal preservation of surrounding tissue. Repairs of MMS defects are often done the same day if performed by the resecting Mohs surgeon. However, for more complicated reconstructive procedures, repairs are often performed by a separate reconstructive surgeon. When this occurs, MMS repairs may be delayed and performed on a different day due to a variety of factors such as surgical scheduling conflicts and patient tolerance. Researchers are urgently trying to explore the implications and postoperative complications of delayed MMS as compared to same day MMS. OBJECTIVE: This study compares same-day vs. next day eyelid reconstruction following MMS with attention to postoperative complications. Our aim is to investigate whether or not a delay in closure is associated with an increase in postoperative complications. METHODS: We performed a retrospective chart review of patients who underwent eyelid reconstruction following MMS from January 2008 to December 2018, by a single private practice oculoplastic surgeon. The timing of each patient’s reconstruction along with age, sex, comorbidities, such as diabetes, current smoking status, previous radiation therapy, anticoagulation treatment, and occurrence of postoperative complications were recorded. The specific location of the defect was recorded as well. The timing of reconstruction was classified as same-day or next-day reconstruction. No reconstructions took place more than 48 hours after tumor excision. The complications included in our analysis were: hematoma, wound infection, flap necrosis, dehiscence, and ectropion. Statistical significance was determined by Pearson’s chi-squared analysis. RESULTS: A total of 485 procedures were performed on 390 patients. 334 (69%) of those procedures were same-day reconstructions, while 151 (31%) of those procedures were next-day reconstructions. 19 (5.7%) of the 334 same-day reconstructions and 9 (5.9%) of the 151 next-day reconstructions were associated with complications (p=0.905). Therefore, a total of 28 (5.8%) procedures were associated with complications. More women (54%) than men (46%) underwent reconstruction. Multivariate logistic regression showed that males had a 1.274-fold higher risk of developing complication post reconstruction. Current smokers had a 1.054-fold higher risk of developing complications post reconstruction. CONCLUSIONS: There is no statistically significant difference in the postoperative complication rate when comparing same-day vs. next-day eyelid reconstruction following Mohs micrographic surgery.

Basal cell carcinoma is the most common form of human malignancy, and as such there are varied methods for treating its various forms. Its more advanced and aggressive forms have required both the use of and advent of therapies which offer differing safety profiles, cost, and efficacy. Two therapies which differ substantially in these respects but have overlap in their recommended use are Mohs micrographic surgery and the pharmaceutical drug vismodegib. Few studies have sought to compare the two methods using these criteria, and as vismodegib has only received FDA approval in the past ten years, it is worthwhile to explore the limitations and advantages of each therapy. In exploring previous clinical trials and retrospective studies, the two therapies are put side by side to contrast their results with their shared intended use. The general findings were that Mohs micrographic surgery remains the gold standard for the treatment of locally advanced basal cell carcinoma, and there are few demonstrable instances in which vismodegib could be deemed a more appropriate therapy. The future of vismodegib appears to be in its use as a neoadjuvant therapy for locally advanced basal cell carcinomas for which a decrease in size by vismodegib would allow for better treatment outcomes.

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