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July 2018

Reevaluating Mohs Surgery Appropriate Use Criteria for Primary Superficial Basal Cell Carcinoma

Author Affiliations
  • 1US Dermatology Partners, Texas, Grapevine
  • 2Australasian College of Cutaneous Oncology, Docklands, Victoria, Australia
  • 3Department of Dermatology, University of California, Irvine
JAMA Dermatol. 2018;154(7):755-756. doi:10.1001/jamadermatol.2018.0111

Based on the biology of primary superficial basal cell carcinoma (sBCC), most sBCCs currently scored as “appropriate” by the Mohs surgery appropriate use criteria (MAUC)1 for treatment with Mohs surgery (MS) should be reclassified as “uncertain” or “inappropriate.”

Superficial BCCs are generally indolent, low-risk, often histologically multifocal skin cancers exhibiting minimal or no dermal invasion. Studies suggest that they may comprise 17% to 30% of all BCCs. Superficial BCCs have a mean thickness of 0.30 mm and seldom penetrate more than 1 mm down hair follicles.2 This makes them amenable to surgical and nonsurgical treatments, including MS, curettage (alone or combined with electrodessication, cryotherapy, or imiquimod), cryotherapy, and topical imiquimod and fluorouracil.3

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