Document Type

Article

Publication Title

SKIN: The Journal of Cutaneous Medicine

Abstract

Introduction
Mohs micrographic surgery is a highly effective treatment for non-melanoma skin cancers, with low complication rates. Despite a baseline surgical site infection rate of approximately 2%, prophylactic antibiotic use remains common, though its benefit is uncertain. The primary objective of this systematic review is to evaluate whether the benefits of prophylactic antibiotic use in Mohs micrographic surgery outweigh the potential risks, particularly with regard to preventing surgical site infection.

Methods
This systematic review was conducted in accordance with PRISMA guidelines. A comprehensive PubMed search identified studies published between 2010 and 2025 that investigated antibiotic use before, during, or after MMS. Eligible studies included randomized controlled trials, systematic reviews, meta-analyses, observational studies, and surveys. Thirteen studies met inclusion criteria, encompassing oral, intra-incisional, and topical interventions.

Results
Evidence from randomized trials and observational studies showed no consistent benefit of oral prophylactic antibiotics, with surgical site infection rates comparable to controls. In contrast, intra-incisional antibiotic administration significantly reduced SSI risk (RRs 0.18–0.32), and topical decolonization with mupirocin showed benefit in both Staphylococcus aureus carriers and non-carriers. Surveys highlighted substantial variability and frequent overprescription of antibiotics, often exceeding guideline recommendations. Overall certainty of evidence was low to moderate due to heterogeneity, retrospective design, and inconsistent surgical site infection definitions.

Conclusion
Routine postoperative oral prophylaxis does not significantly reduce SSI after Mohs micrographic surgery and may expose patients to unnecessary risks. Localized approaches, including intra-incisional antibiotics and topical decolonization, demonstrated greater efficacy and warrant further study. Prophylactic decisions should remain individualized for high-risk patients until high-quality randomized trials better define optimal strategies and inform updated guidelines.

DOI

10.25251/1ed5p251

Publication Date

7-2026

Keywords

Mohs micrographic surgery, antibiotic prophylaxis, surgical site infection, Dermatologic Surgery, dermatology

ISSN

2574-1624

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