title: Risk of synchronous and metachronous second nonmelanoma skin cancer when referred for Mohs micrographic surgery.
abstract: BACKGROUND
  Patients with basal cell carcinoma and cutaneous squamous cell carcinoma are at substantial risk for the onset of a second nonmelanoma skin cancer (NMSC).
  
  
  OBJECTIVE
  Our purpose was to determine the incidence of multiple (synchronous) NMSC at presentation to an academic Mohs micrographic surgery referral center and to note the incidence of second lesions occurring in a metachronous fashion.
  
  
  METHODS
  A retrospective study was conducted of 456 consecutive patients who presented for Mohs surgery over a 2-year period. Patients were assessed at initial visits for the presence of multiple NMSCs and were subsequently examined over 2 years for the onset of new NMSCs.
  
  
  RESULTS
  More than 39% of patients initially referred for Mohs surgery with a basal cell or squamous cell carcinoma either presented with multiple primary lesions or experienced a subsequent NMSC within 2 years. These tumors were divided almost equally between multiple primary NMSC at presentation and subsequent (metachronous) tumors.
  
  
  CONCLUSIONS
  Patients referred for Mohs surgery in an academic setting are a select group at extremely high risk of additional NMSCs at or shortly after presentation for the index lesion.
authors.affiliation: University of Vermont College of Medicine and Fletcher Allen Health Care Center, UHC Campus, Burlington, Vermont 05401, USA.
authors.forename: M
authors.initials: M
authors.lastname: Schinstine
authors.forename: G D
authors.initials: GD
authors.lastname: Goldman
mesh_terms: D002280:Basal Cell Carcinoma / Q000150:complications / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D015580:Mohs Surgery; D009378:Neoplasms, Multiple Primary / Q000209:etiology*; D016609:Neoplasms, Second Primary / Q000209:etiology*; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery