title: Mohs micrographic surgery in a patient with a deep brain stimulator: a review of the literature on implantable electrical devices.
abstract: BACKGROUND
  Implantable electrical devices are becoming increasingly common in the patient population presenting for Mohs micrographic surgery. In addition to understanding the potential intraoperative complications with implantable cardioverter-defibrillators and pacemakers, the Mohs surgeon needs to be aware of the relatively new treatment of movement disorders using implanted deep brain stimulators.
  
  
  OBJECTIVE
  We present only the second reported case of Mohs surgery in a patient with a deep brain stimulator. In an attempt to help minimize adverse events during a procedure, we review the more commonly encountered electrical devices as well as the newer deep brain stimulators. We provide guidelines for the avoidance of electromagnetic interference during an electrosurgical procedure.
  
  
  METHODS
  This 76-year-old patient with Parkinson's disease and an implanted deep brain stimulator underwent Mohs surgery for excision of a squamous cell carcinoma on the ear. In an attempt to minimize electromagnetic interference with his implanted device, hemostasis was obtained with the aid of a battery-operated heat-generating handheld electrocautery device.
  
  
  RESULTS
  The patient tolerated the procedure well without complications or reports of discomfort.
  
  
  CONCLUSIONS
  Patients with implanted electrical devices are subject to electromagnetic interference during an electrosurgical procedure. Care must be taken in this expanding patient population during a Mohs surgical procedure.
authors.affiliation: Department of Dermatology, Baylor College of Medicine, Houston, Texas 77030, USA. paulmartinelli@hotmail.com
authors.forename: Paul T
authors.initials: PT
authors.lastname: Martinelli
authors.forename: Keith E
authors.initials: KE
authors.lastname: Schulze
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Nelson
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000601:surgery*; D017147:Defibrillators, Implantable; D004428:Ear Neoplasms / Q000150:complications / Q000601:surgery*; D004574:Electromagnetic Fields; D004867:Equipment Design; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D015580:Mohs Surgery; D010138:Pacemaker, Artificial; D010300:Parkinson Disease / Q000150:complications / Q000601:surgery; D017410:Practice Guidelines as Topic