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Journal of the American Academy of Dermatology
Volume 71, n° 1
pages 29-35 (juillet 2014)
Doi : 10.1016/j.jaad.2014.02.025
accepted : 18 February 2014
Original Articles

Application of Mohs micrographic surgery appropriate-use criteria to skin cancers at a university health system

Adam B. Blechman, MD a, James W. Patterson, MD a, b, Mark A. Russell, MD a,
a Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia 
b Department of Pathology, University of Virginia Health System, Charlottesville, Virginia 

Reprint requests: Mark A. Russell, MD, Department of Dermatology, University of Virginia Health System, Box 800718, Charlottesville, VA 22908.

Mohs micrographic surgery (MMS) is an effective treatment for skin cancer. Until recently, it has been difficult to determine the percentage of skin cancers best treated with MMS. The appropriate-use criteria represents an opportunity to more accurately estimate this number.


We sought to apply the appropriate-use criteria retrospectively to University of Virginia Health System skin cancers so as to determine the proportion that met appropriate use within 8 months.


A list of all biopsy-proven skin cancers, excluding invasive melanoma, at the University of Virginia Health System during an 8-month period was generated. Patient and tumor data were collected retrospectively from hospital records and each skin cancer was classified as appropriate, inappropriate, or uncertain based on the appropriate-use criteria.


Among 1059 skin cancers, MMS was appropriate in 72.0% of cases, inappropriate in 20.4%, and uncertain in 7.6%. Altogether, 59.3% of skin cancers occurred in H and M areas, which include the head, neck, hands, feet, ankles, genitalia, nipples/areola, and pretibial surface.


Patient and tumor information was collected retrospectively at 1 institution.


Using recently published appropriate-use criteria, 72.0% of skin cancers at this institution were appropriate for MMS. Tumor location was the most important factor in determining appropriate use.

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

Key words : appropriate-use criteria, Mohs micrographic surgery, skin cancer

Abbreviations used : BCC, MIS, MMS, SCC, SCCIS

 Funding sources: None.
 Conflicts of interest: None declared.

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