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Journal of the American Academy of Dermatology
Volume 39, n° 5
pages 698-703 (novembre 1998)
Doi : 10.1016/S0190-9622(98)70041-6
accepted : 20 July 1998
Mohs micrographic surgery: A cost analysis
 

Joel Cook, MDa, John A. Zitelli, MDb
Charleston, South Carolina, and Pittsburgh, Pennsylvania 

Abstract

Background: The incidence of skin cancer is increasing significantly, and many people have declared the increase an epidemic. It was estimated that 900,000 to 1.2 million cases of nonmelanoma skin cancer occurred in the United States in 1994. With increasing pressure to deliver cost-effective medical care, physicians must understand the cost and value of the various methods to treat skin cancer. Objective: Our purpose was to define the true cost of treating a series of skin cancers with the Mohs micrographic technique and compare our costs with calculated estimates of the costs to treat the same cancers with traditional methods of surgical excision. Methods: A group of 400 consecutive tumors was selected. The cost of treatment in the reference group included diagnosis, Mohs micrographic surgery, reconstruction (if applicable), follow-up, and the cost to treat disease recurrence. These costs were then compared with traditional methods of surgical excision: excision with permanent section margin control, excision with frozen section margin control, and excision with frozen section margin control in an ambulatory surgical facility. For cost comparisons, it was assumed that all tumors in the comparison groups would be excised with standard surgical margins and the resultant surgical defects would be reconstructed with the simplest method possible. The costs of diagnosis, excision, pathology, reconstruction, and the cost to treat disease recurrence were then calculated and compared with the costs of treating the lesions with Mohs micrographic surgery. Results: Our calculation of costs documents that Mohs micrographic surgery is similar in cost to office-based traditional surgical excision and less expensive than ambulatory surgical facility–based surgical excision. The average cost of Mohs micrographic surgery was $1243 versus $1167 for excision with permanent section margin control, $1400 for excision in the office with frozen section margin control, and $1973 for excision with frozen section margin control in an ambulatory surgical facility. Analysis based on anatomic location yielded similar results. Conclusion: Mohs micrographic surgery is a method of surgical excision with high intrinsic value that is cost-effective in comparison to traditional surgical excision. (J Am Acad Dermatol 1998;39:698-703.)

The full text of this article is available in PDF format.

 From the Department of Dermatology, Medical University of South Carolina, a and the University of Pittsburgh Medical Center.b
 Reprint requests: Joel Cook, MD, Department of Dermatology, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425. E-mail: cookjw@musc.edu
 0190-9622/98/$5.00 + 0   16/1/93162

*  *Standard surgical margins are defined as follows: 4 mm for BCC, 4 to 6 mm for SCC, 2.0 cm for dermatofibrosarcoma protuberans, 0.5 to 2.0 cm for malignant melanoma, and 6 mm for other tumor types.17, 18, 19, 20


© 1998  American Academy of Dermatology, Inc. Published by Elsevier Masson SAS@@#104157@@
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