title: How many nonmelanoma skin cancers require Mohs micrographic surgery?
abstract: BACKGROUND
  Cost containment in health care is currently a subject of much debate. The rapid spread of managed care is an attempt to influence practice trends and contain costs. Although seldom directly stated, it is implied that some physicians may perform high-cost procedures when not necessarily indicated, an example being Mohs micrographic surgery (MMS).
  
  
  OBJECTIVE
  There are little data in the literature indicating what percentage of skin cancers treated by MMS would be appropriate. For such data to be meaningful, a model would have to exist wherein there is no financial incentive or disincentive for performing the procedure. Military medicine provides this unique environment.
  
  
  METHODS
  In a retrospective review, we counted the total number of basal cell carcinomas and squamous cell carcinomas diagnosed at Brooke Army Medical Center (BAMC) over a 5-year period. We then determined the number of MMS cases performed on these cancers.
  
  
  RESULTS
  A total of 5193 nonmelanoma skin cancers (NMSC) were diagnosed at BAMC and 1701 of these were treated by MMS. Overall, the percentage of NMSC treated by MMS was 32.7% for the 5-year period.
  
  
  CONCLUSIONS
  This information may serve as a framework for physicians and health delivery systems as they negotiate managed care contracts for the management of skin cancer.
authors.affiliation: Dermatology Service, Brooke Army Medical Center, Ft. Sam Houston, Texas 78234, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Welch
authors.forename: L L
authors.initials: LL
authors.lastname: Anderson
authors.forename: W J
authors.initials: WJ
authors.lastname: Grabski
mesh_terms: D002280:Basal Cell Carcinoma / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D006801:Humans; D015580:Mohs Surgery / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000601:surgery*