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Feb 2012

The Webb and Rivera (WAR) Score: A Preoperative Mohs Surgery Assessment Tool

Author Affiliations

Author Affiliations: Department of Dermatology, Northeast Regional Medical Center, Kirksville, Missouri (Drs Rivera and Cleaver); and Tennessee River Dermatology, Florence, Alabama (Dr Webb).

Arch Dermatol. 2012;148(2):206-210. doi:10.1001/archdermatol.2011.1352

Objective To make available a simple, quantitative formula for preoperative assessment of both the complexity and the associated time required to complete Mohs surgical cases. It will improve office efficiency, technical performance, and resource management.

Design Surveys were sent to 94 Mohs surgeons requesting information on 10 consecutive cases, including tumor size, recurrence, location, aggressiveness, stages required, and case duration. The data were then aggregated, scored, and statistically evaluated.

Setting Private practice dermatology offices performing Mohs surgery were included.

Participants Sequential randomized selection of Mohs College and Mohs Society fellows was used for inclusion. Sequential selection of patients for data acquisition was performed by the surgeons.

Main Outcome Measure The statistical significance of a proposed preoperative assessment tool was to be determined.

Results The score ρ values were 0.34 and 0.41 for the time and number of stages, respectively. In addition, the Mohs score obtained a statistically significant P value of <.001 for both the time and number of stages required.

Conclusions The Webb and Rivera (WAR) score is a low-effort, efficient, reproducible tool to be used in preoperative Mohs surgery planning and office efficiency improvement. The components of the score include maximum tumor dimension, recurrence, location, and aggressiveness. Each is assigned a numerical value that is totaled, resulting in a final quantitative score.