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Comment & Response
September 2018

Age and Treatment of Nonmelanoma Skin Cancer

Author Affiliations
  • 1Department of Dermatology, Indiana University School of Medicine, Indianapolis
JAMA Surg. 2018;153(9):867. doi:10.1001/jamasurg.2018.1696

To the Editor Nonmelanoma skin cancers (NMSC) are the most common malignancies in the United States, with an annual incidence of greater than 3.5 million. As a result, the average cost for NMSC treatment has exponentially risen to more than 4 billion dollars from 2007 to 2011. Furthermore, patients older than 65 years represent a disproportionate sample. Rising costs prompted the American Academy of Dermatology and the American College of Mohs Surgery to publish meaningful use criteria in 2012 for NMSC and melanoma skin cancers. The expert panel outlined evidence-based criteria for 212 NMSC scenarios, which account for cost, patient characteristics, cosmesis, and tumor characteristics. Briefly, all basal cell carcinomas and squamous cell carcinomas on high-risk and medium-risk sites were deemed appropriate for Mohs referral except for superficial basal cell carcinomas less than 0.5 cm on a medium-risk site and squamous cell carcinomas focally arising within an actinic keratosis.1 Although the criteria reflects expert opinion, the expert panel astutely recognized that the guidelines do not replace clinician judgement. These same guidelines are similarly used by dermatologists for responsible referral to plastic surgery.2

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