Smokers have more complications after surgery for skin cancer

According to a US study, complications after skin cancer surgery may be more common among smokers and former smokers.

The researchers looked at the results after the "Mohs Reconstruction", a procedure aimed at eliminating a cancerous lesion of the skin. Once the cancer is removed, often from the head or neck, surgeons can close the site using a flap made from surrounding tissue or a skin graft taken from another part of the body.

For this study, the researchers examined the results obtained from 1,008 patients who had undergone Mohs reconstruction with flaps or grafts, including 128 current smokers and 385 former smokers.

Compared to people who have never smoked, current smokers were more than nine times more likely to have complications such as infections, clots called hematomas, uncontrolled bleeding or dead skin tissues. Ex-smokers were more than three times more likely to have these acute complications.

"Smoking with adverse effects on wound healing and outcomes … has been documented for other procedures, but not previously for the repair of wounds with flaps and grafts after removal of cancer from the skin, "said Dr. Ian Maher, a professor of dermatology at the University of Minnesota in Minneapolis and lead author of the study.

"Good circulation is necessary for a good cure," Maher said by e-mail. "Smoking damages small blood vessels in many organs, including the skin. Poor circulation slows healing and prepares patients for complications such as an infection. "

Overall, 41 people in the study, or 4.1%, had acute complications.

This included 19 cases of infection; 10 cases of necrosis or dead tissue at the site of the flap or graft; 10 cases of wound separation; and 6 cases of clots or uncontrolled bleeding. Some patients had more than one complication.

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One of the limitations of the study is that researchers lacked data on the number of people smoked or their duration, as well as on the recent date when former smokers might have quit .

Even in this case, current and former smokers should be aware of the increased risk of acute complications and do everything in their power to minimize this risk, said Dr. James Dinulos, founder of Seacoast Dermatology in Portsmouth, Ontario. New Hampshire, and badociate clinical professor. of surgery at the Geisel School of Medicine in Dartmouth, Hanover.

"Smoking has a negative impact on the early stages of wound healing, resulting in an increase in the complications described in the study," said Dinulos, not involved in the study, by email. "It is likely that the chemicals in the smoke affect the integrity of the skin in the long run, especially if the patient smokes a lot, and some physiological changes may not be reversible."

Quitting smoking is always better than continuing to smoke, and some patients may delay surgery in order to start quitting, said Dinulos.

"It is well known that quitting smoking can reverse the damaging physiological effects of smoking, including improving breathing, improving cardiovascular function, reducing the risk of stroke and cancer risk," said Dr. Graham. Warren of the Hollings Cancer Center of the Medical. University of South Carolina in Charleston, who also did not participate in the study.

"When it comes to skin cancer, patients who say they have already smoked probably have the benefits of quitting on vascular and immune function," Warren said by email.