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

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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.


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.


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.


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.


Patient and tumor information was collected retrospectively at 1 institution.


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.

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