Cost Analysis: Mohs Micrographic Surgery
Larisa Ravitskiy
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Abstract
BACKGROUND With the continuing increase in the incidence of skin cancer, delivery of cost-efficient skin cancer treatment is a top priority.
Key takeaways
- A variety of methods have been applied in treatment of NMSC, including topical agents such as 5-fluorouracil and imiquimod; destruction with electrodesiccation and curettage (ED&C), cryotherapy, or laser ablation; standard surgical excision (SSE); Mohs micro-graphic surgery (MMS); radiation therapy; and photodynamic therapy.
- In 1998, a study was published showing there was little difference in cost between MMS ($1,243) and SSE with margin control using paraffin sections ($1,167).
- Based on a study by Rowe and colleagues, 10.1% of tumors treated with SSE and 1.0% of those treated with MMS would recur.
- Even for tumors on the trunk and extremities, areas where most tumors are traditionally treated with excision, MMS remains the least-expensive option.
- 13, Our results confirm that tumors treated with SSE require flap and graft repairs three times more often than the same tumors treated with MMS.
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Dermatology Reports
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Archives of Dermatology, 2012
To identify Medicare use rates of Mohs micrographic surgery (MMS) and surgical excision for the treatment of nonmelanoma skin cancer (NMSC) and to identify patient, lesion, and geographic characteristics associated with treatment type. Design: A retrospective analysis of Medicare beneficiaries.
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Journal of the American Academy of Dermatology, 2010
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Indication guidelines for Mohs micrographic surgery in skin tumors
Anais Brasileiros de Dermatologia, 2016
Mohs micrographic surgery is a technique used to excise skin tumors based on comprehensive surgical mapping, in which the surgeon removes the tumor, followed by a complete histological evaluation of the tumor's margins. The correlation of the presence of a tumor in histological examinations and its precise location on the surgical map result in a complete removal of the tumor with maximum normal tissue preservation. The present article seeks to provide general practitioners and healthcare specialists with guidelines regarding recommendations for Mohs micrographic surgery to treat skin tumors, based on the most reliable evidence available in medical literature on the subject. This bibliographic review of scientific articles in this line of research was conducted based on data collected from MEDLINE/PubMed. The search strategy used in this study was based on structured questions in the Patient, Intervention, Control, and Outcome (PICO) format. MeSH terms were used as descriptors. The indications of this technique are related to recurrence, histology, size, definition of tumor margins, and location of tumors. These guidelines attempt to establish the indications of Mohs surgery for different types of skin tumors.
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Journal of Cutaneous Medicine and Surgery, 2018
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Journal of the American Academy of Dermatology, 2017
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Correlation Between Demographic and Tumor Characteristics in Non-melanoma Skin Cancers Submitted to Mohs Micrographic Surgery
In Vivo, 2020
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Mohs micrographic surgery: a treatment method for many non-melanocytic skin cancers
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Treatment of cutaneous melanoma of the face by Mohs micrographic surgery
Journal of cutaneous medicine and surgery
The treatment of cutaneous malignant melanoma of the face presents a challenge to ensure eradication of disease with maximum preservation of tissue. Mohs micrographic surgery provides a means for histologically controlled removal of malignant melanoma. This study evaluates the efficacy of Mohs micrographic surgery, at a single institution, for the treatment of facial melanoma and assesses the accuracy of margin control by frozen section techniques. Ninety-seven patients with biopsy-confirmed melanoma in situ or invasive melanoma of the face were treated by Mohs micrographic surgery over a 6-year period. In 25 patients, tissue margins defined as negative for melanoma at the time of frozen section were re-evaluated on permanent section histology of formalin-fixed, paraffin-embedded tissue. Ninety-two of 97 patients had followup information available (8-72 months; mean 33 months). There were no cases of local recurrence. Eighty-nine of the 92 patients were alive and well with no eviden...
Cost-effectiveness of Mohs Micrographic Surgery vs Surgical Excision for Basal Cell Carcinoma of the Face
Archives of Dermatology, 2006
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Dermatologic Surgery, 2012
The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate use criteria for 270 scenarios for which Mohs micrographic surgery (MMS) is frequently considered based on tumor and patient characteristics. This document reflects the rating of appropriateness of MMS for each of these clinical scenarios by a ratings panel in a process based on the appropriateness method developed by the RAND Corp
AAD/ACMS/ASDSA/ASMS 2012 Appropriate Use Criteria for Mohs Micrographic Surgery: A Report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Su
Dermatologic Surgery, 2012
The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate use criteria for 270 scenarios for which Mohs micrographic surgery (MMS) is frequently considered based on tumor and patient characteristics. This document reflects the rating of appropriateness of MMS for each of these clinical scenarios by a ratings panel in a process based on the appropriateness method developed by the RAND Corp
Mohs Micrographic Surgery and Cutaneous Oncology
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Mohs micrographic surgery for the treatment of primary cutaneous melanoma
Journal of The American Academy of Dermatology, 1997
Mohs micrographic surgery is thought to be a useful therapy for cutaneous melanoma. Controversy persists, however, because there are few published reports that document its safety and efficacy.
Mohs micrographic surgery: analysis of 39 cases
Surgical & Cosmetic Dermatology, 2016
Introduction: Mohs micrographic surgery is a technique that offers high cure rates for non-melanoma skin cancer. Objective: To describe the clinical and epidemiological profile of patients who underwent Mohs micrographic surgery in a reference center in dermatologic surgery. Methods: Medical records of patients who underwent Mohs micrographic surgery in the period 2014-2015 at a dermatology reference center, in the city of Mogi das Cruzes (SP, Brazil), were analyzed. Results: The patients' ages ranged from 38 to 87 years; of these 54% were women. The most affected topography was the nose (54% of patients). Previous history of skin cancer was positive in 62% of cases. The indication driver for micrographic surgery was the lesion's location in 67% of the patients, followed by the size (23%) and tumor recurrence (10%). The most prevalent intraoperative diagnosis was basal cell carcinoma (90%). Conclusions: Mohs micrographic surgery is an excellent therapeutic option in cases of tumors of aggressive nature, large diameter and high-risk location. This study is in line with the current literature regarding the epidemiological data linked to the occurrence of nonmelanoma skin cancer.
Non-Melanoma Skin Cancer Treated with Mohs Micrographic Surgery in Thailand
Journal of the Medical Association of Thailand, 2018
Background: Long-term follow-up, complications, and patient satisfaction are essential outcome measures regarding the bene its of Mohs micrographic surgery [MMS] for treating non-melanoma skin cancers [NMSCs]. Objective: To report risk factors, clinical indings, and follow-up outcomes of all NMSC patients treated with MMS. Materials and Methods: The present retrospective study included all patients in the outpatient Dermatology Clinic of Siriraj Hospital, Bangkok, Thailand, with NMSC treated with MMS between 2008 and 2013. The outcomes measured were patient demographic data, duration of tumor, recurrence of tumor before MMS, number of lesions, risk factors for developing skin cancer, histological type and subtype, location of tumor, pre-operative and post-operative size, method of closure, operative time, 5-year recurrence rate after MMS, complications, and patient satisfaction. Results: The present study included 108 patients (63% females and 37% males) with a mean age of 70±12 years (range 36 to 93 years). The mean duration of tumor was 37±60 months (range 0.5 to 480 months). Basal cell carcinoma [BCC] comprised 95.1% of cases, whereas squamous cell carcinoma [SCC] was 4.9%. The signi icant risk factor for both BCC and SCC was sun exposure. The most common locations for both BCC and SCC were the head and neck regions. The most common subtype for BCC was a non-aggressive subtype, 47%. The most commonly used method of closure was second intention, 28 cases (22.8%). The mean operative time was 116.13 minutes (range: 30 to 360 minutes). During the longest follow-up time (60 months), the recurrence rate was 0.81%. There were no major complications. The majority (96.4%) of patients gave a 75% to 100% satisfaction rate after surgery. Conclusion: The present study demonstrates less than one percent recurrence rate in NMSCs treated with MMS and the necessity of margin control in high-risk tumors.
Mohs micrographic surgery: a review of indications, technique, outcomes, and considerations☆☆☆
2021
Mohs micrographic surgery is a specialized form of skin cancer surgery that has the highest cure rates for several cutaneous malignancies. Certain skin cancers can have small extensions or “roots” that may be missed if an excised tumor is serially cross-sectioned in a “bread-loaf” fashion, commonly performed on excision specimens. The method of Mohs micrographic surgery is unique in that the dermatologist (Mohs surgeon) acts as both surgeon and pathologist, from the preoperative considerations until the reconstruction. Since Dr. Mohs’s initial work in the 1930s, the practice of Mohs micrographic surgery has become increasingly widespread among the dermatologic surgery community worldwide and is considered the treatment of choice for many common and uncommon cutaneous neoplasms. Mohs micrographic surgery spares the maximal amount of normal tissue and is a safe procedure with very few complications, most of them managed by Mohs surgeons in their offices. Mohs micrographic surgery is t...
Micrographic surgery of skin cancer in German hospitals 2005-2006
Journal of the European Academy of Dermatology and Venereology, 2011
Background/Objective Surgical therapy of skin cancer includes conventional wide excision and micrographic surgery (MS). Little is known about the population-wide spread of MS for the treatment of skin cancer. The aim was to estimate the in-hospital use of MS for the treatment of skin cancer in Germany. Methods We used nationwide DRG data from 2005 through 2006. We identified hospitalizations with a main diagnosis of cutaneous malignant melanoma (CMM) (ICD-10: C43) or non-melanoma skin cancer (NMSC)
Mohs Micrographic Surgery
Encyclopedia of Cancer
Mohs micrographic surgery (MMS) is used to obtain clear margins in skin cancer treatment. MMS involves staged excisions and complete margin assessment of the specimen from fresh tissue frozen sectioning. It has been shown to achieve higher cure rates with malignancies, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), lentigo maligna, melanoma in situ and dermatofibrosarcoma protuberans. This technique is especially useful in face, feet and hand regions to avoid cosmetic deformities.
Association Between Type of Reconstruction After Mohs Micrographic Surgery and Surgeon-, Patient-, and Tumor-Specific Features: A Cross-Sectional Study
Dermatologic Surgery, 2013
BACKGROUND There are few data to indicate whether the type of final wound defect is associated with the type of post-Mohs repair.
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