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Appropriate Use Guidelines Validate Mohs Micrographic Surgery

The American Academy of Dermatology recently adopted its first official appropriate use criteria for Mohs micrographic surgery. The approval is expected to bring increased acceptance and understanding of the procedure by doctors, patients, and insurers.

Milwaukee, Wisconsin (June 2012) - Dr. Marc D. Brown, president of the American College of Mohs Surgery (ACMS) (, says that increases in the use of Mohs surgery for skin cancer treatment have been substantiated now that appropriate use criteria for the procedure have been adopted.

At its annual meeting this spring in San Diego, the American Academy of Dermatology, in collaboration with the ACMS, approved the final guidelines.

"The new appropriate use criteria support the effectiveness of Mohs surgery as a treatment for many types of skin cancer, particularly non-melanoma skin cancer," Dr. Brown says. "The guidelines also validate the cost-effectiveness of Mohs surgery and the important role of the ACMS surgeon."

The use of Mohs surgery as a skin cancer treatment in the U.S. increased by 400 percent between 1995 and 2009. Currently, one in four skin cancers are being treated with Mohs. This sharp uptick drew the attention of some insurers and raised questions as to whether the procedure was being overused.

Dr. Brown is quick to point out that there are several factors that contributed to the increase in Mohs procedures. "The use of Mohs is on the rise for several reasons - because of the nation's skin cancer epidemic and because of the fact that Mohs is so effective, both clinically and from a cost perspective." There are also more surgeons being trained in the Mohs procedure, making it more widely available.

ACMS member surgeons complete extensive fellowship training specifically in Mohs surgery. Mohs surgeons can microscopically examine and evaluate tissue at the time of surgery to determine which cells are cancerous and which are not. This allows them to remove the entire tumor - and only the tumor - while leaving more surrounding tissue unharmed than with traditional surgical methods.

According to the ACMS, one of the main advantages of Mohs micrographic surgery is that all cancerous cells are removed, making it less likely that the cancer will return. Mohs surgery has the highest success rate of all skin cancer treatments - up to 99%.

Dr. Brown explains that Mohs is a very cost-effective way to treat skin cancer as well. "The Mohs College surgeon is specifically trained as a cancer surgeon, pathologist, and reconstructive surgeon, meeting all of the patient's needs on an outpatient basis."

Typically, local anesthesia is used, so the patient is awake during the entire procedure. Using local anesthesia eliminates the risk of side effects that are possible with general anesthesia and eases the post-surgery recovery period. He warns, however, that Mohs is a very precise procedure that requires the skill of a highly trained and experienced surgeon.

"Don't trust your Mohs surgery to just anyone," he says. "It should only be done by ACMS members who have completed extensive fellowship training specifically in the Mohs micrographic surgery procedure."


A graduate of Georgetown University School of Medicine and a professor of dermatology and oncology at University of Rochester Medical Center, Dr. Marc D. Brown is the current president of the American College of Mohs Surgery (/). Dr. Brown performs Mohs surgery on more than 2,000 patients a year and is a frequent teacher and lecturer at local and national meetings focusing on Mohs surgery, melanoma, facial reconstruction and challenging and unusual skin cancers.

Last updated: June 10, 2015