title: Economic impact of preoperative curettage before Mohs micrographic surgery for basal cell carcinoma.
abstract: BACKGROUND
  The role of curettage before Mohs micrographic surgery for basal cell carcinoma (BCC) remains controversial. Preoperative curettage may allow the surgeon to better delineate the subclinical extensions of high-risk BCCs, thereby enabling a more precise first-stage excision around tumor-containing tissue.
  
  
  OBJECTIVE
  To assess the economic impact of preoperative curettage for high-risk BCCs treated with Mohs micrographic surgery on patients, providers, and insurers.
  
  
  METHODS
  Given the enormous variability in practice styles, it was estimated that the time required to complete a second stage of Mohs surgery was 25, 50, or 75% of that required to complete the first stage. New York City Medicare and Standard reimbursement rates were used to approximate the cost of an additional stage of Mohs surgery for high-risk BCCs.
  
  
  RESULTS
  Assuming that preoperative curettage increases operative efficiency by reducing the number of required Mohs stages from 2 to 1, the time saved can be quantified. Thus, if the Mohs surgeon estimates that the time required to remove a second stage is 75% of that of the first stage, the time savings with preoperative curettage equals 75% of the duration of a one-stage Mohs surgery. Similarly, when a second stage requires 50 or 25% of the time needed to complete the first stage, the time saved equals 50 or 25% of the duration of a one-stage Mohs surgery. Reducing the number of stages from 2 to 1 saves insurers and privately paying patients approximately $250 and $500, respectively.
  
  
  CONCLUSIONS
  Whether preoperative curettage can offer a more precise first-stage excision without compromising tissue conservation remains a subject of debate. Preoperative curettage may reduce the number of Mohs surgical stages required for tumor clearance, potentially shortening patient encounters and allowing surgeons to treat additional patients, while decreasing costs for patients and insurers.
authors.affiliation: Department of Dermatology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Lee
authors.forename: Désirée
authors.initials: D
authors.lastname: Ratner
mesh_terms: D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003475:Curettage / Q000191:economics*; D018588:Fee-for-Service Plans; D006801:Humans; D006278:Medicare; D015580:Mohs Surgery / Q000191:economics*; D009519:New York City; D011300:Preoperative Care / Q000191:economics*; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*