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Institutional Adherence to Current Mohs Surgery Appropriate Use Criteria With Reasons for Nonadherence and
Eugen Stancut1, Olivia G Melvin2, Russell L Griffin3
1Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama.
Background:
The appropriate use criteria (AUC) were established to optimize the use of Mohs micrographic surgery (MMS) and confer the highest possible clinical benefit to the patient.
Objective:
We documented our adherence to AUC and review reasons for nonadherence regarding lesions classified as inappropriate, in the hopes of informing future versions of the AUC.
Materials And Methods:
A retrospective review of 1,000 consecutive patients who underwent MMS at a single institution. A total of 1,318 biopsy-proven nonmelanoma skin cancers were treated with MMS, and each skin cancer that underwent MMS was classified as appropriate, uncertain, or inappropriate based on the AUC.
Results:
Data were collected on 1,318 lesions with 1,237 (93.9%) categorized as appropriate, 59 (4.5%) uncertain, and 22 (1.7%) not appropriate. The primary variables that determined appropriateness were type of cancer (p = .001), size (p < .001), and area of body (p < .001).
Conclusion:
Institutional adherence to AUC was high, with 93.9% of treated tumors classified as appropriate, 4.5% as uncertain and 1.7% as inappropriate. By far the most commonly reported reason for performing MMS on an inappropriate lesion in our review was the treatment of adjacent lesions in 1 session.
Insights
This study found high adherence to Mohs micrographic surgery (MMS) appropriate use criteria (AUC), with 93.9% of cases meeting guidelines. Nonadherence was mainly due to treating adjacent lesions simultaneously.
Area of Science:
- Dermatology
- Surgical Oncology
- Health Policy
Background:
- Appropriate Use Criteria (AUC) guide Mohs micrographic surgery (MMS) for optimal patient benefit.
- Evaluating adherence to AUC is crucial for refining surgical guidelines.
Purpose of the Study:
- To assess institutional adherence to AUC for MMS.
- To identify reasons for nonadherence to inform future AUC revisions.
Main Methods:
- Retrospective review of 1,000 patients undergoing MMS.
- Classified 1,318 nonmelanoma skin cancers based on AUC (appropriate, uncertain, inappropriate).
Main Results:
- 93.9% of lesions were appropriate, 4.5% uncertain, and 1.7% inappropriate.
- Cancer type, size, and body area significantly influenced appropriateness.
- Treating adjacent lesions concurrently was the primary reason for performing MMS on inappropriate cases.
Conclusions:
- High institutional adherence to MMS AUC was observed.
- Understanding reasons for nonadherence, like treating multiple lesions, can improve AUC.
- Findings support refining AUC for complex cases.
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