Abstract
Surgical error due to incorrect identification of the surgical site has been known to occur right from the beginning of surgical practice through the ages. However, increasing awareness, preventative efforts and risks of litigation have not eliminated this problem. Cutaneous surgery for skin cancer makes up a large proportion of procedures performed each year and it is often difficult to correctly identify biopsy sites, especially as this is not easy in sun-damaged skin. In this review article, we review the incidence of wrong-site surgery, measures taken by professional bodies, and the use of photography and newer technologies in an attempt to eliminate this distressing event in the field of plastic and dermatologic surgery. The purpose of this review is to highlight the incidence of such surgical site identification errors, evaluate the risk factors, and educate the surgeon about measures that can be undertaken to avoid being faced with such a situation.
Highlights
In the United States, more than 1.3 million new non-melanoma skin cancers (NMSC) occur each year, causing significant morbidity and being responsible for high healthcare costs [1]
Paul tients with melanoma presenting for wider excisions, or patients with non-melanoma skin cancers presenting for formal excision after an initial biopsy
While the margins needed for a wide excision have been whittled down, most experts agree that mortality after local recurrence is high and that a wide excision offers the best chance of a cure [12]
Summary
In the United States, more than 1.3 million new non-melanoma skin cancers (NMSC) occur each year, causing significant morbidity and being responsible for high healthcare costs [1]. In plastic and dermatologic surgery, skin cancers present a high risk for pa-. (2015) Errors in Surgical Site Identification during Cutaneous Surgery for Skin Cancer: Review and Recommendations. Paul tients with melanoma presenting for wider excisions, or patients with non-melanoma skin cancers presenting for formal excision after an initial biopsy. In a survey of referrals for Moh’s micrographic surgery, without photography, patients incorrectly identified 16.6% to 29% of biopsy sites [2] [3]. Often a biopsy is performed by a different physician who refers the patient to another for more complex surgery. A survey showed that wrong-site surgery was among the most common reasons for a lawsuit against Moh’s surgeons [5]. Stiff penalties have been established by institutions such as the Board of Medicine in Florida, demonstrating the public’s not unreasonable intolerance to wrong-site surgery [10]
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