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Frequency doubled for Mohs' micrographic surgery in treating nonmelanoma skin cancer

Use of Mohs' micrographic surgery as treatment for nonmelanoma skin cancer increased substantially in recent years among Medicare beneficiaries, according to study results.

Researchers performed a retrospective analysis on Medicare patients who underwent Mohs' micrographic surgery (MMS) or surgical excision to treat nonmelanoma skin cancer (NMSC) from Jan. 1, 2001 to Dec. 31, 2006. The study was designed to establish the frequency of these procedures within the cohort and determine any associations between treatment type and specific patient characteristics.

Within the evaluated time period, patients underwent 26,931 operations related to NMSC, 9,802 (36.4%) of which were MMS and 17,129 (63.6%) of which were surgical excisions. The use of the Mohs procedure doubled from 0.75 to 1.5 per 100 Medicare patients, while the rate for surgical excisions increased slightly (from 1.8 to 2.1 per 100 beneficiaries).

Patient characteristics significantly associated with MMS treatment included age (P<.001), geographic location (P<.001) and race (P=.005). MMS was conducted on men (36.9%) and women (35.8%) almost equally. MMS was performed on 40.6% of patients aged 67 to 69 years, compared with 33.5% among patients aged 85 years and older, with surgical excision more common among the older group. Participants located in the West and Northeast were most likely to undergo MMS, while those in the Midwest and Pacific regions of the country were least likely. White patients were more likely to receive MMS than black patients (36.5% vs. 23.1%) or those identified as other races (28.7%). The location of the lesion also was significantly associated with MMS, with lesions on the face more likely to be treated with MMS than those on other parts of the body (P<.001).

“The use of MMS has been steadily increasing during the past decade, with MMS representing approximately one-third of all surgical procedures for NMSC,” the researchers wrote. “To our knowledge, this is the only study to examine the national patterns of use for MMS for NMSC over time. … Additional large, prospective studies are needed to further identify surgical treatment outcomes for NMSC.”