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Groups develop appropriate use criteria for Mohs' surgery

Four dermatology and surgical organizations have created appropriate use criteria for 270 Mohs’ micrographic surgery scenarios.

A 17-member ratings panel, composed of eight Mohs’ surgeons and nine non-Mohs’ dermatologists, conducted three rounds of individual scoring, including face-to-face meetings and conference calls. A nine-point scale was used to rate Mohs’ micrographic surgery (MMS) as appropriate (7 to 9), uncertain (4 to 6) or inappropriate (1 to 3) for each scenario. Consensus was defined as 12 panel members rating a procedure within the same category.

After successive rounds and an additional email ballot, the panel reached consensus. Two hundred (74.07%) scenarios were deemed appropriate, 24 (8.89%), uncertain and 46 (17.04%), inappropriate. Of 69 scenarios for basal cell carcinoma, 76.81% were deemed appropriate, 8.70%, uncertain and 14.49%, inappropriate. Of 143 scenarios with squamous cell carcinoma, 71.33% were appropriate, 4.90%, uncertain and 23.78%, inappropriate. Twelve scenarios involved lentigo maligna and melanoma in situ, with 83.33% deemed appropriate, 16.67%, uncertain and 0%, inappropriate. In 46 scenarios involving rare cutaneous malignancies, 76.09% were deemed appropriate, 19.57%, uncertain, and 4.35%, inappropriate.

“These appropriate use criteria [AUC] for Mohs’ surgery embody a unique effort to develop criteria to support the efficient use of medical resources while providing the highest quality care for patients who will benefit the most,” dermatologist and panel chairwoman Suzanne M. Connolly, MD, said. “The goal of the AUC is to provide evidence-based guidance on which types of skin cancer cases are most appropriate for this specialized surgery.”

The panel cautioned that scenarios rated uncertain “would benefit from further research.”

“Each clinical scenario identified … is crafted for the average patient and not the exception,” the panel concluded.

The AUC was developed through a collaborative effort by the American Academy of Dermatology, the American College for Mohs Surgery, the American Society for Dermatologic Surgery Association and the American Society for Mohs Surgery.

Disclosure: See the study for a full list of relevant disclosures.