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Evaluation and Management of Hypertension in the Perioperative Period of Mohs Micrographic Surgery: A Review

Larson, Rebecca J. MD*; Aylward, Juliet MD

Dermatologic Surgery:
doi: 10.1111/dsu.0000000000000012
Review Article

BACKGROUND: While patients’ hypertensive problems are usually actively and effectively managed by their primary physician, the dermatologic surgeon can still be affected by hypertension where the condition is unrecognized or uncontrolled. Hypertension is an important contributor to both bleeding and hematoma formation during and after surgery, ultimately affecting functional and cosmetic outcomes.

OBJECTIVE: To extensively review the literature on perioperative management of the hypertensive patient as relates to the dermatologic surgeon.

MATERIALS AND METHODS: An updated and comprehensive literature review, focusing on current diagnostic guidelines, practice by specific dermatologic surgery groups and management recommendations, was conducted.

RESULTS: Review of the literature does support generalized guidelines for the management of hypertensive patients in the Mohs Micrographic Surgery (MMS) setting; however data on implementation and outcomes by specific dermatologic surgery groups is variable and lacking.

CONCLUSIONS: The treatment of nonmelanoma skin cancers with MMS is now routine, and fortunately can be performed quite safely. There are still improvements to be made however, in managing perioperative hypertension—both in making patients aware of their condition and in treating it effectively. Practicing these measures can promote patients’ overall health and the efficiency of the dermatologic surgeon’s practice.

Author Information

*Department of Dermatology, Southern Illinois University School of Medicine, Springfield, Illinois;

Department of Dermatology, West Clinic, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin

Address correspondence and reprint requests to: Rebecca J. Larson, MD, Southern Illinois University School of Medicine, 751 N Rutledge St., PO Box 19644, Springfield, IL 62794-9644, or e-mail:

The authors have indicated no significant interest with commercial supporters.

© 2014 Lippincott Williams & Wilkins, Inc.

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