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Beyond Skin Tumors: A Systematic Review of Mohs Micrographic Surgery in the Treatment of Deep Cutaneous Fungal Infections.

BACKGROUND
Deep cutaneous fungal infections (DCFIs) can cause significant morbidity in immunocompromised patients and often fail medical and standard surgical treatments because of significant subclinical extension. Although rarely considered in this setting, Mohs micrographic surgery (MMS) offers the advantages of comprehensive margin control and tissue conservation, which may be beneficial in the treatment of DCFIs that have failed standard treatment options.


OBJECTIVE
To review the benefits, limitations, and practicality of MMS in patients with DCFIs.


METHODS
A systematic review of PubMed and EMBASE was conducted to identify all cases of fungal skin lesions treated with MMS.


RESULTS
Eight case reports were identified consisting of a total of 8 patients. A majority of patients had a predisposing comorbidity (75%), with the most common being a solid organ transplant (n = 3, 37.5%). The most commonly diagnosed fungal infection was phaeohyphomycosis (n = 5, 62.5%), followed by mucormycosis (n = 2, 25%). No recurrence or complication post-MMS was noted at a mean follow-up of 11.66 months.


CONCLUSION
Although not a first-line treatment, MMS can be considered as an effective treatment alternative for DCFIs in cases of treatment failure and can be particularly helpful in areas where tissue conservation is imperative.