DS27 Checking blood pressure of patients having Mohs surgery: a survey of practice of UK- and Australasia-based Mohs surgeons

Abstract Mohs surgeons’ approach to preoperative hypertension appears to vary and may lead to cancelled lists (personal communication), as some consider hypertension a contributory risk factor for bleeding and haematoma. We sought to obtain formal opinion via a survey of Mohs surgeons. In December 2024, a brief six-question e-survey was circulated to all 103 registered UK-based Mohs surgeons (British Society for Dermatological Surgery) and the 77 Mohs surgeons based in Australasia (Australia and New Zealand: ANZ) via the Australasian College of Dermatologists. The response rates were 50% (52 of 103) and 26% (20 of 77), respectively. Based on branching logic survey methodology, the third question was linked to three further questions. In total, 24 UK respondents had performed Mohs for < 10 years (11 in ANZ), 19 respondents for 10–19 years (eight in ANZ) and nine for > 20 years (one respondent in ANZ). Overall, 63% of UK-based and 60% of ANZ-based respondents believed ‘that hypertension during Mohs surgery contributes to bleeding’. In total, 19% of UK-based and 10% of ANZ-based respondents ‘did not know if hypertension causes increased bleeding’. Only 37% of UK-based respondents check blood pressure on the day of Mohs surgery, compared with 80% of Australasian respondents. The cutoff for abnormally high blood pressure (BP) in the context of Mohs respondents was as follows: 140/90 mmHg (UK 3%, ANZ 0%), 160/100 mmHg (UK 15%, ANZ 24%), 180/100 mmHg (UK 36%, ANZ 35%) and 200/100 mmHg (UK 45%, ANZ 41%). The answers to question 5 were diverse: ‘If you felt BP was high, what would you do?’. Responses were ‘postpone starting Mohs and re-check BP reading after a period of rest’ (UK 37%, ANZ 19%), ‘prescribe a single dose of anti-hypertensive then proceed with Mohs (UK 5%, ANZ 19%) and ‘BP noted but no treatment given and proceed with Mohs (UK 37%, ANZ 38%). ‘Other’ open comment themes included determining signs of malignant hypertension, checking what their baseline BP was with the patient and/or general practitioner, refer to an emergency department or give a benzodiazepine (e.g. low-dose sublingual diazepam 2 mg). The decision was influenced by the Mohs surgeon’s preference and site of the surgery. There was a wide range of opinions with different thresholds for medical treatment and choice of antihypertensive for each Mohs surgeon. Some surgeons would operate at 180/100 mmHg. From ANZ, glyceryl trinitrate, ramipril and sublingual nifedipine were given as antihypertensives. However, felodipine was commonly used in the UK. The results confirm a range of practice and no consensus. Further discussion and an evidence-based guideline would be helpful to develop more consistent practice.