Author Affiliation: Department of Dermatology, Northwestern Feinberg School of Medicine, Chicago, Illinois.
The lack of evidence-based management algorithms for the treatment of nonmelanoma skin cancer (NMSC) is a practice gap. Practicing physicians have no algorithm of care for the most common cancer, NMSC. In the absence of algorithms, there is regional variation in the use of Mohs surgery. Consensus regarding tumor pathologic type, diameter, and anatomical location led to definitions of low risk for recurrence and high risk for recurrence of NMSC. Chren et al1 demonstrated adherence to a protocol in a single institution for low-risk vs high-risk NMSC. Mohs surgery is predominantly used to treat facial lesions, especially of the lip and eyelid, where the tissue-sparing benefit is most needed. The crux of the concern is that the doubling rate of Mohs surgery from 2001 to 2006 may be due to overuse of Mohs surgery for primary NMSC, especially in patients younger than are included in this Medicare population.
Robinson JK. Use of Mohs Micrographic Surgery for the Treatment of Nonmelanoma Skin CancerComment on “Mohs Micrographic Surgery and Surgical Excision for Nonmelanoma Skin Cancer Treatment in the Medicare Population”. Arch Dermatol. 2012;148(4):477-478. doi:10.1001/archdermatol.2011.3159