Elderly patients are at risk for Mohs micrographic surgery–related depression

Ocular Pathology/Oncology, Oculoplastics/Orbit

Psychosocial distress, including depression, has been reported following Mohs micrographic surgery, and the risk for psychosocial distress appears to increase with age.

Study design

Sixty-three patients who underwent Mohs micrographic surgery completed a standardized depression questionnaire, the Patient Health Questionnaire-8, before the procedure and at postoperative weeks 1, 2, 4, 6, and 12. Changes in scores over time were evaluated.


Seventy-nine percent of patients underwent procedures on the head and neck. Over the 12 weeks, scores increased (indicating worsening depression) in 35% of patients, although scores did not differ by tumor location and the likelihood of increased scores did not vary by tumor location. Changes in scores were not statistically significantly different between patients with and without mood disorders. However, patients in the oldest age group (83–99 years) experienced higher scores at weeks 4 and 6 than patients in younger age groups and demonstrated statistically significant increases in depression at weeks 4 and 6.


The sample size was relatively small. Contrary to previous investigations, patients with facial tumors did not experience greater depression in this study. The increased mask wearing seen during the COVID-19 pandemic may have affected the results.

Clinical significance

While the presence of a facial tumor that required surgery did not result in increased risks of depression, many patients who were undergoing Mohs procedures experienced elevated scores on a depression index. Given that older patients appeared more likely to have self-reported depression, these results might indicate that better screening for depression and improved attention to its issues to help this population navigate the surgical experience are needed.

Financial Disclosures: Dr. Edward Wladis discloses financial relationships with FuzeHub, Lions Eye Foundation (Grant Support) and Horizon Therapeutics (Consultant/Advisor; Lecture Fees/Speakers Bureau); and is a patent holder.

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