Application of Mohs micrographic surgery appropriate-use criteria to skin cancers at a university health system

• Published in: Journal of the American Academy of Dermatology Vol. 71; no. 1; pp. 29 - 35
• Main Authors: Blechman, Adam B., MD, Patterson, James W., MD, Russell, Mark A., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2014
• Subjects: Academic Medical Centers; appropriate-use criteria; Carcinoma in Situ - pathology; Carcinoma in Situ - surgery; Carcinoma, Basal Cell - pathology; Carcinoma, Basal Cell - surgery; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Dermatology; Dermatology - standards; Facial Neoplasms - pathology; Facial Neoplasms - surgery; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - surgery; Humans; Mohs micrographic surgery; Mohs Surgery - standards; Mohs Surgery - statistics & numerical data; Patient Selection; Practice Guidelines as Topic; Retrospective Studies; skin cancer; Skin Neoplasms - pathology; Skin Neoplasms - surgery; Squamous Cell Carcinoma of Head and Neck; Virginia; Virginia; Mohs micrographic surgery; skin cancer; melanoma in situ; MMS; SCC; BCC; appropriate-use criteria; MIS; squamous cell carcinoma in situ; basal cell carcinoma; SCCIS; squamous cell carcinoma
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2014.02.025

Background Mohs micrographic surgery (MMS) is an effective treatment for skin cancer. Until recently, it has been difficult to determine the percentage of skin cancers best treated with MMS. The appropriate-use criteria represents an opportunity to more accurately estimate this number. Objective We sought to apply the appropriate-use criteria retrospectively to University of Virginia Health System skin cancers so as to determine the proportion that met appropriate use within 8 months. Methods A list of all biopsy-proven skin cancers, excluding invasive melanoma, at the University of Virginia Health System during an 8-month period was generated. Patient and tumor data were collected retrospectively from hospital records and each skin cancer was classified as appropriate, inappropriate, or uncertain based on the appropriate-use criteria. Results Among 1059 skin cancers, MMS was appropriate in 72.0% of cases, inappropriate in 20.4%, and uncertain in 7.6%. Altogether, 59.3% of skin cancers occurred in H and M areas, which include the head, neck, hands, feet, ankles, genitalia, nipples/areola, and pretibial surface. Limitations Patient and tumor information was collected retrospectively at 1 institution. Conclusions Using recently published appropriate-use criteria, 72.0% of skin cancers at this institution were appropriate for MMS. Tumor location was the most important factor in determining appropriate use.