Is Mohs surgery painful? An Israeli’s study perspective

This research article was published online on June 1st, 2022 in Dermatologic Surgery.

This study aims to survey patients’ postoperative pain levels after undergoing Mohs micrographic surgery (MMS) and examine the various variables that affect pain perception. It included about 2,000 Israeli patients (54% men and 46% women), all operated by the same surgeon at the same facility from March 2017 to March 2019. The following day after the MMS procedure, patients were instructed to report pain levels once a day on a scale of 1-10 (1 low and 10 high) for seven days until suture removal. 

Pain levels were highest on the first postoperative day with a mean of 1.55/10, decreasing levels as days passed. On the third day, 22% of women and 18% of men had pain levels of 2/10 or higher. It was found that patients’ age did not significantly influence pain perception. Rather, certain areas such as the scalp, forehead, nose, and ear contributed to higher pain levels (~ 2/10). Reconstruction methods also affected pain perception, especially for those with split-thickness skin grafts (2.38/10). Less than 25% of patients needed non-narcotics like Tylenol or Advil and mainly consumed them in the first four days of recovery. 

Some advantages found in this study are its large cohort and consistency of preoperative, surgical, and postoperative techniques. Limitations include the lack of diverse ethnicities in patients. Additionally, the pain scale is too simple and overlooks additional data that can better relate to the evaluation of MMS postoperative pain.

MMS has a low level of postoperative pain across all genders and ages although larger tumor sizes and certain areas may increase pain levels. This study is not the first of its kind but it does include a larger cohort size than most studies found. From my expertise, this study seems to match my patients’ postoperative experiences except the study design makes it difficult to know which agents work. This research is an important addition to the literature that MMS can be performed safely without an operating room in addition to yielding minimal post-operative pain.