Patients with chronic lymphocytic leukemia (CLL) have an increased risk of aggressive skin cancer, infection, and bleeding, because of their underlying disease. 1–3 Ibrutinib is a Bruton tyrosine kinase inhibitor associated with increased bleeding risk, and dermatologic surgery case reports have implicated ibrutinib as a cause of bleeding-related complications. 3, 4 The goal of our study was to investigate risk factors associated with postoperative complications in CLL patients undergoing Mohs surgery. Based on previously published cases, we hypothesized that ibrutinib therapy would be associated with significant bleeding-related adverse events.

We performed a 10-year retrospective chart review and included patients with CLL who underwent Mohs surgery. Complications included bleeding-related complications, infection, and dehiscence that occurred within 2 weeks of surgery. Bleeding-related complications were defined as persistent postoperative bleeding, hematoma, or significant bruising with swelling warranting additional follow-up after suture removal. For case–control subset analysis to investigate bleeding risk from ibrutinib, complications from patients on ibrutinib were compared with (1) patients on any anticoagulant and no CLL therapy and to (2) patients on no anticoagulants nor CLL therapy. Categorical variables were compared by Fisher exact test or 2 sample t-test as appropriate.