P201 Fish skin grafts for Mohs defects: a promising alternative in dermatological surgery

Abstract Post-Mohs’ surgical defect repair remains a challenge, particularly in complex wounds, complicated by patient factors such as senescent wound healing, nutrition, anticoagulation, comorbidities and access to specialist care. These factors may deter the surgeon from complex reconstructions; however, secondary healing can also be resource intensive. We present a series of wounds healed with acellular fish skin grafts (AFSGs) as a novel option for Mohs wound repair. AFSGs, derived from Atlantic cod and Nile tilapia, have shown promise due to their anti-inflammatory, antimicrobial and proregenerative properties. Structurally, cod-derived fish skin closely resembles human dermis. In our dermatological surgery unit, we treated five patients with nonmelanoma skin cancers using AFSGs following Mohs micrographic surgery. All patients self-identified as White, and their median age was 63 years (range 46–77). Anatomical sites included two basal cell carcinomas on the nasal region, one on the jawline, one on the frontal scalp and one on the occipital area. Following complete tumour excision with clear histological margins, AFSG was applied directly to the defect and secured using Steri-Strips or absorbable sutures. Patients were reviewed weekly over 6 weeks. In two cases, a second application was required following natural resorption of the initial graft. Notably, no infections, graft rejection or contractures were observed. The grafts were well tolerated, with no reports of pain, allergic reaction or delayed healing. At 3 months postoperatively, none of the patients exhibited keloid or hypertrophic scarring, and all expressed satisfaction with the aesthetic outcomes. There were no contour abnormalities in the treated sites despite the depth of the wounds. Our findings suggest that AFSGs represent a viable and effective alternative in the reconstructive algorithm for Mohs defects, particularly for patients seeking minimal donor-site morbidity and improved cosmetic outcomes. Further studies are essential to validate the efficacy, cost-effectiveness and long-term results.