Evaluation and management of hypertension in the perioperative period of Mohs micrographic surgery: a review.
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.


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.
*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.
Rebecca J
RJ
Larson
Juliet
J
Aylward
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000009:adverse effects*; D000772:Anesthesia, Local / Q000009:adverse effects* / Q000379:methods; D016063:Blood Loss, Surgical / Q000517:prevention & control; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D015201:Meta-Analysis as Topic; D015580:Mohs Surgery / Q000009:adverse effects / Q000379:methods; D016343:Monitoring, Intraoperative / Q000379:methods; D059035:Perioperative Period; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D012878:Skin Neoplasms / Q000150:complications* / Q000601:surgery; D013530:Surgical Wound Infection / Q000517:prevention & control; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000009:adverse effects; D059466:White Coat Hypertension / Q000175:diagnosis / Q000188:drug therapy
D000759:Adjuvants, Anesthesia; D014662:Vasoconstrictor Agents; D004837:Epinephrine