User:Harveyandlucie/sandbox

= Introduction =

Mohs surgery is a method where one surgeon cuts out skin cancer, analyses all of the edges microscopically to check removal and then repairs the defect in one process.

Level 1 evidence is the strongest available to guide decision making. It is usually derived from randomized controlled trials.

The content of this page lists and describes some characteristics of the existing level 1 Mohs evidence: citations; key Medical Subject Headings (MeSH); the total number of patients randomized (n).

Citations of randomized controlled trials
The US National Library of Medicine was searched using these MeSH: "Mohs" and "Randomized Controlled Trial" on 14th April 2019. 1991

Robins P, Ashinoff R. Prolongation of anesthesia in Mohs micrographic surgery with 2% lidocaine jelly. The Journal of dermatologic surgery and oncology. 1991 Aug;17(8):649-52.

7 citations.

MeSH: Anesthesia, Local.

n=58

1995

Fazio MJ, Zitelli JA. Full-thickness Skin Grafts: Clinical Observations on the Impact of Using Epinephrine in Local Anesthesia of the Donor Site. Arch Dermatol. 1995;131(6):691–694.

20 citations.

MeSH: Anesthesia, Local; Graft survival; Skin Transplantation/methods.

n=72

1998

Griego, Robert D., and John A. Zitelli. "Intra-incisional prophylactic antibiotics for dermatologic surgery." Archives of dermatology 134.6 (1998): 688-692.

73 citations.

MeSH: Penicillins/therapeutic use; Surgical Wound Infection/prevention&control.

n=790

1999

Baumann LS, Spencer J. The effects of topical vitamin E on the cosmetic appearance of scars. Dermatologic Surgery. 1999 Apr;25(4):311-5.

178 citations.

MeSH: Wound healing/drug effects.

n=15

Jackson BA, Shelton AJ. Pilot study evaluating topical onion extract as treatment for postsurgical scars. Dermatologic surgery. 1999 Apr;25(4):267-9.

98 citations.

MeSH: Wound healing/drug effects.

n=17

2000

Dunn CL, Brodland DG, Griego RD, Huether MJ, Fazio MJ, Zitelli JA. A single postoperative application of nitroglycerin ointment does not increase survival of cutaneous flaps and grafts. Dermatologic surgery. 2000 May;26(5):425-7.

24 citations.

MeSH: Wound healing/drug effects.

n=168

2002

Huether MJ, Griego RD, Brodland DG, Zitelli JA. Clindamycin for intraincisional antibiotic prophylaxis in dermatologic surgery. Archives of dermatology. 2002 Sep 1;138(9):1145-8.

37 citations.

MeSH: Antibiotic Prophylaxis; Surgical Wound Infection/prevention&control.

n=1030

2004

Huang CC, Boyce S, Northington M, Desmond R, Soong SJ. Randomized, controlled surgical trial of preoperative tumor curettage of basal cell carcinoma in Mohs micrographic surgery. Journal of the American Academy of Dermatology. 2004 Oct 1;51(4):585-91.

30 citations.

MeSH: Preoperative Care.

n=166

Smeets NW, Krekels GA, Ostertag JU, Essers BA, Dirksen CD, Nieman FH, Neumann HM. Surgical excision vs Mohs' micrographic surgery for basal-cell carcinoma of the face: randomised controlled trial. The Lancet. 2004 Nov 13;364(9447):1766-72.

321 citations.

MeSH: Neoplasm Recurrence, Local.

n=565

Torres A, Niemeyer A, Berkes B, Marra D, Schanbacher C, González S, Owens M, Morgan B. 5% imiquimod cream and reflectance‐mode confocal microscopy as adjunct modalities to Mohs micrographic surgery for treatment of basal cell carcinoma. Dermatologic surgery. 2004 Dec;30(12p1):1462-9.

100 citations.

MeSH: Combined Modality Therapy; Treatment Outcome.

n=72

2005

Moody BR, McCarthy JE, Linder J, Hruza GJ. Enhanced cosmetic outcome with running horizontal mattress sutures. Dermatologic surgery. 2005 Oct;31(10):1313-6.

39 citations.

MeSH: Suture Techniques; Treatment Outcome.

n=55

2006

Essers BA, Dirksen CD, Nieman FH, Smeets NW, Krekels GA, Prins MH, Neumann HM. Cost-effectiveness of Mohs micrographic surgery vs surgical excision for basal cell carcinoma of the face. Archives of dermatology. 2006 Feb 1;142(2):187-94.

126 citations.

MeSH: Mohs surgery/economics.

n=408

2007

Sniezek PJ, Walling HW, DeBloom III JR, Messingham MJ, Vanbeek MJ, Kreiter CD, Whitaker DC, Arpey CJ. A randomized controlled trial of high‐viscosity 2‐octyl cyanoacrylate tissue adhesive versus sutures in repairing facial wounds following Mohs micrographic surgery. Dermatologic surgery. 2007 Aug;33(8):966-71.

37 citations.

MeSH: Postoperative care; Sutures; Tissue Adhesives.

n=14

2008

Mailler-Savage EA, Neal Jr KW, Godsey T, Adams BB, Gloster Jr HM. Is levofloxacin necessary to prevent postoperative infections of auricular second‐intention wounds?. Dermatologic Surgery. 2008 Jan;34(1):26-31.

14 citations.

MeSH: Surgical Wound Infection/prevention & control.

n=84

Mosterd K, Krekels GA, Nieman FH, Ostertag JU, Essers BA, Dirksen CD, Steijlen PM, Vermeulen A, Neumann HA, Kelleners-Smeets NW. Surgical excision versus Mohs' micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years' follow-up. The lancet oncology. 2008 Dec 1;9(12):1149-56.

354 citations.

MeSH: Neoplasm Recurrence, Local.

n=612

Hanke CW, Leonard AL, Reed AJ. Rapid preparation of high‐quality frozen sections using a membrane and vacuum system embedding machine. Dermatologic Surgery. 2008 Jan;34(1):20-5.

17 citations.

MeSH: Frozen sections/instrumentation.

n=75

2009

Butler DF, Parekh PK, Lenis A. Imiquimod 5% cream as adjunctive therapy for primary, solitary, nodular nasal basal cell carcinomas before Mohs micrographic surgery: a randomized, double blind, vehicle‐controlled study. Dermatologic Surgery. 2009 Jan;35(1):24-9.

37 citations.

MeSH: Combined Modality Therapy.

n=31

Tierney EP, Moy RL, Kouba DJ. Rapid absorbing gut suture versus 2-octylethylcyanoacrylate tissue adhesive in the epidermal closure of linear repairs. Journal of drugs in dermatology: JDD. 2009 Feb;8(2):115-9.

13 citations.

MeSH: Wound Healing; Treatment Outcome; Tissue Adhesives/chemistry.

n=8

Tierney E, Mahmoud BH, Srivastava D, Ozog D, Kouba DJ. Treatment of surgical scars with nonablative fractional laser versus pulsed dye laser: a randomized controlled trial. Dermatologic surgery. 2009 Aug;35(8):1172-80.

103 citations.

MeSH: Lasers/Dye therapeutic use; Postoperative Complications;  Treatment Outcome.

n=12

Morganroth PA, Gelfand JM, Jambusaria A, Margolis DJ, Miller CJ. A randomized, double-blind comparison of the total dose of 1.0% lidocaine with 1: 100,000 epinephrine versus 0.5% lidocaine with 1: 200,000 epinephrine required for effective local anesthesia during Mohs micrographic surgery for skin cancers. Journal of the American Academy of Dermatology. 2009 Mar 1;60(3):444-52.

13 citations.

MeSH: Anesthetics, Local.

n=149

Muller FM, Dawe RS, Moseley H, Fleming CJ. Randomized comparison of Mohs micrographic surgery and surgical excision for small nodular basal cell carcinoma: tissue‐sparing outcome. Dermatologic Surgery. 2009 Sep;35(9):1349-54.

67 citations.

MeSH: Treatment Outcome; Follow-Up Studies.

n=30

2010

Rosenzweig LB, Abdelmalek M, Ho J, Hruza GJ. Equal cosmetic outcomes with 5‐0 poliglecaprone‐25 versus 6‐0 polypropylene for superficial closures. Dermatologic Surgery. 2010 Jul;36(7):1126-9.

17 citations.

MeSH: Sutures; Treatment Outcome; Wound Healing.

n=44

Guardiano RA, Grande DJ. A direct comparison of visual inspection, curettage, and epiluminescence microscopy in determining tumor extent before the initial margins are determined for Mohs micrographic surgery. Dermatologic Surgery. 2010 Aug;36(8):1240-4.

14 citations.

MeSH: Curettage; Dermoscopy, Preoperative Care.

n=54

2011

Ravitskiy L, Phillips PK, Roenigk RK, Weaver AL, Killian JM, Schott AH, Otley CC. The use of oral midazolam for perioperative anxiolysis of healthy patients undergoing Mohs surgery: conclusions from randomized controlled and prospective studies. Journal of the American Academy of Dermatology. 2011 Feb 1;64(2):310-22.

29 citations.

MeSH: Anti-Anxiety Agents.

n=44

Xia Y, Cho S, Greenway HT, Zelac DE, Kelley B. Infection rates of wound repairs during Mohs micrographic surgery using sterile versus nonsterile gloves: a prospective randomized pilot study. Dermatologic surgery. 2011 May;37(5):651-6.

35 citations.

MeSH: Surgical Wound Infection; Gloves, Surgical.

n=60

Sniezek PJ, Brodland DG, Zitelli JA. A randomized controlled trial comparing acetaminophen, acetaminophen and ibuprofen, and acetaminophen and codeine for postoperative pain relief after Mohs surgery and cutaneous reconstruction. Dermatologic Surgery. 2011 Jul;37(7):1007-13.

51 citations.

MeSH: Pain.

n=210

Plotner AN, Mailler-Savage E, Adams B, Gloster Jr HM. Layered closure versus buried sutures and adhesive strips for cheek defect repair after cutaneous malignancy excision. Journal of the American Academy of Dermatology. 2011 Jun 1;64(6):1115-8.

11 citations.

MeSH: Suture Techniques.

n=38

Bagheri S, King T, Justiniano H, Eisen DB. Maintaining tissue orientation during mohs micrographic surgery: scalpel versus marker. Dermatologic Surgery. 2011 Oct;37(10):1412-6.

2 citations.

MeSH: Mohs Surgery/methods.

n=101

2012

Van der Geer S, Martens J, Van Roij J, Brand E, Ostertag JU, Verhaegh ME, Neumann HA, Krekels GA. Imiquimod 5% cream as pretreatment of Mohs micrographic surgery for nodular basal cell carcinoma in the face: a prospective randomized controlled study. British Journal of Dermatology. 2012 Jul;167(1):110-5.

30 citations.

MeSH: Adjuvants;  Mohs Surgery/methods.

n=70

Gurgen J, Gatti M. Epiluminescence microscopy (dermoscopy) versus visual inspection during Mohs microscopic surgery of infiltrative basal cell carcinoma. Dermatologic Surgery. 2012 Jul 1;38(7):1066-9.

9 citations.

MeSH: Dermoscopy.

n=40

2013

Verhaeghe E, Ongenae K, Dierckxsens L, Bostoen JE, Lambert J. Nonablative fractional laser resurfacing for the treatment of scars and grafts after Mohs micrographic surgery: a randomized controlled trial. Journal of the European Academy of Dermatology and Venereology. 2013 Aug;27(8):997-1002.

14 citations.

MeSH: Laser Therapy.

n=24

Vachiramon V, Sobanko JF, Rattanaumpawan P, Miller CJ. Music reduces patient anxiety during Mohs surgery: an open‐label randomized controlled trial. Dermatologic Surgery. 2013 Feb;39(2):298-305.

43 citations.

MeSH: Music; Anxiety/prevention&control.

n=100

Tai YJ, Borchard KL, Gunson TH, Smith HR, Vinciullo C. Nasal carriage of S taphylococcus aureus in patients undergoing M ohs micrographic surgery is an important risk factor for postoperative surgical site infection: A prospective randomised study. Australasian Journal of Dermatology. 2013 May;54(2):109-14.

35 citations.

MeSH: Surgical Wound Infection/prevention & control; Risk Factors.

n=203

Regan T, Lawrence N. Comparison of Poliglecaprone‐25 and Polyglactin‐910 in Cutaneous Surgery. Dermatologic Surgery. 2013 Sep;39(9):1340-4.

12 citations.

MeSH: Sutures/adverse effects.

n=140

Cherian P, Gunson T, Borchard K, Tai Y, Smith H, Vinciullo C. Oral antibiotics versus topical decolonization to prevent surgical site infection after Mohs micrographic surgery—a randomized, controlled trial. Dermatologic surgery. 2013 Oct;39(10):1486-93.

32 citations.

MeSH: Surgical Wound Infection/prevention & control; Antiobiotic Prophylaxis.

n=179

2014

Ryu HJ, Choi JE, Ahn HH, Kye YC, Seo SH. A comparison of the scar prevention effect between carbon dioxide fractional laser and pulsed dye laser in surgical scars. Dermatologic Surgery. 2014 Sep 1;40(9):973-8.

39 citations.

MeSH: Mohs surgery/adverse effects; Lasers Dye or Gas/therapeutic use.

n=14

van Loo E, Mosterd K, Krekels GA, Roozeboom MH, Ostertag JU, Dirksen CD, Steijlen PM, Neumann HM, Nelemans PJ, Kelleners-Smeets NW. Surgical excision versus Mohs’ micrographic surgery for basal cell carcinoma of the face: a randomised clinical trial with 10 year follow-up. European journal of cancer. 2014 Nov 1;50(17):3011-20.

111 citations.

MeSH: Neoplasm recurrence; Treatment Outcome.

n=612

2015

Sobanko JF, Vachiramon V, Rattanaumpawan P, Miller CJ. Early postoperative single treatment ablative fractional lasing of Mohs micrographic surgery facial scars: A split‐scar, evaluator‐blinded study. Lasers in surgery and medicine. 2015 Jan;47(1):1-5.

21 citations.

MeSH: Postoperative Complications/prevention & control; Lasers Gas/therapeutic use.

n=20

Blouin MM, Al Jasser M, Demanczuk A, Berkowitz J, Zloty D. Continuous versus interrupted sutures for facial surgery repair: a randomized prospective study. Dermatologic Surgery. 2015 Aug 1;41(8):919-28.

MeSH: Suture Techniques.

n=105.

3 citations.

2016

Zaiac M, Daoud A, Lawrence K, Prado G, Miller N, Garces S, Recine M. Enhancing the antiseptic properties of nonsterile disposable gloves: A prospective randomized pilot study of a novel sterilization technique for dermatologic surgery. Journal of the American Academy of Dermatology. 2016 Jun 1;74(6):1262-4.

MeSH: Antisepsis; Surgical Wound Infection/prevention & control.

n=56

0 citations.

Kannan S, Mehta D, Ozog D. Scalp closures with pulley sutures reduce time and cost compared to traditional layered technique—a prospective, randomized, observer-blinded study. Dermatologic Surgery. 2016 Nov 1;42(11):1248-55.

MeSH: Suture Techniques.

n=21

8 citations.

2017

Sobanko JF, Da Silva D, Fuxench ZC, Modi B, Shin TM, Etzkorn JR, Samimi SS, Wanat KA, Miller CJ. Preoperative telephone consultation does not decrease patient anxiety before Mohs micrographic surgery. Journal of the American Academy of Dermatology. 2017 Mar 1;76(3):519-26.

MeSH: Anxiety/prevention & control; Preoperative Period; Telephone.

n=104

13 citations.

Reserva J, Kozel Z, Krol C, Speiser J, Adams W, Tung R. Processing Adipose-Rich Mohs Samples: A Comparative Study of Effectiveness of Pretreatment With Liquid Nitrogen Versus Flash Freezing Spray. The American Journal of Dermatopathology. 2017 Nov 1;39(11):838-41.

MeSH: Specimen Handling/methods.

n=24

0 citations.

Kovacs M, Karsai S, Podda M. Superiority of occipital donor sites for split‐thickness skin grafting in dermatosurgery: Results of a prospective randomized controlled study. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2017 Oct;15(10):990-7.

MeSH: Mohs Surgery/methods; Skin Transplantation/methods.

n=108

2 citations.

Chen E, Patel RA, Kwak YJ, Huang CC. Randomized controlled pilot study of the preoperative use of brimonidine 0.33% topical gel for hemostasis in Mohs micrographic surgery. Journal of the American Academy of Dermatology. 2017 Dec 1;77(6):1114-8.

MeSH: Hemostatic technique.

n=24

2 citations.

2018

Zelickson BR, Goldberg LH, Rubenzik MK, Wu WJ. Finer needles reduce pain associated with injection of local anesthetic using a minimal insertion injection technique. Dermatologic Surgery. 2018 Feb 1;44(2):204-8.

MeSH: Pain Procedural/prevention & control; Lidocaine/administration & dosage.

n=318

2 citations.

Golda N, Huber A, Gole H. Determining the impact of intraoperative smoke evacuation on the patient experience during outpatient surgery: A randomized controlled trial. Journal of the American Academy of Dermatology. 2018 May 1;78(5):1007-9.

MeSH: Smoke/prevention & control; Mohs Surgery/methods.

n=160

0 citations.

Chen P, Smith H, Vinciullo C. Bupivacaine as an adjunct to lidocaine in Mohs micrographic surgery: a prospective randomized controlled trial. Dermatologic Surgery. 2018 May 1;44(5):607-10.

MeSH: Anesthetics Local/administration & dosage; Mohs Surgery/methods.

n=51

2 citations.

Hawkins SD, Koch SB, Williford PM, Feldman SR, Pearce DJ. Web app–and text message–based patient education in Mohs micrographic surgery—a randomized controlled trial. Dermatologic Surgery. 2018 Jul 1;44(7):924-32.

MeSH: Patient Education; Mobile Applications.

n=90

5 citations.

2019

Smith H, Borchard K, Cherian P, Tai Y, Vinciullo C. Randomized Controlled Trial of Preoperative Topical Decolonization to Reduce Surgical Site Infection for Staphylococcus aureus Nasal Swab–Negative Mohs Micrographic Surgery Patients. Dermatologic Surgery. 2019 Feb 1;45(2):229-33.

MeSH: Surgical Wound Infection/prevention & control; Preoperative care.

n=1350

3 citations.

Zilinsky I, Barazani TB, Visentin D, Ahuja K, Martinowitz U, Haik J. Subcutaneous Injection of Tranexamic Acid to Reduce Bleeding During Dermatologic Surgery: A Double-Blind, Placebo-Controlled, Randomized Clinical Trial. Dermatologic Surgery. 2019 Jun 1;45(6):759-67.

MeSH: Not available (accessed 17th June 2019) n=127

1 citation.

Trials yet to be reviewed and included:

Kircik L, Del Rosso JQ. Comparative efficacy and safety results of topical hemostatic powder and sterile compressed foam sponge in second intention healing following Mohs micrographic surgery. J Drugs Dermatol. 2010 Feb;9(2):137-40. PubMed PMID: 20214176.

Morales-Burgos A, Loosemore MP, Goldberg LH. Postoperative wound care after dermatologic procedures: a comparison of 2 commonly used petrolatum-based ointments. J Drugs Dermatol. 2013 Feb;12(2):163-4. PubMed PMID: 23377388.

Kircik LH, Dickerson JE Jr, Kitten C, Weedon KA, Slade HB. Allogeneic growth arrested keratinocytes and fibroblasts delivered in a fibrin spray accelerate healing in Mohs micrographic surgery wounds. J Drugs Dermatol. 2013 May;12(5):558-61. PubMed PMID: 23652951.