title: Mohs micrographic surgery: How ACMS fellowship directors practice.
abstract: BACKGROUND
  Mohs micrographic surgery (MMS) is widely employed in the removal of skin cancer. As this technique becomes more widely employed, it is useful to establish the patterns of care provided by American College of Mohs Surgery (ACMS)-approved fellowship directors.
  
  
  OBJECTIVE
  To compile and analyze data collected annually by the ACMS to determine practice patterns and trends in MMS as performed by ACMS-approved fellowship directors.
  
  
  METHODS
  A retrospective study of case logs from 50 fellowship directors obtained from the ACMS detailing case volume, type of cancer treated, location, lesion size, wound size, number of stages, referral percentage, and type of repairs performed.
  
  
  RESULTS
  Annual case volume per surgeon has increased linearly. The incidence of squamous cell carcinoma treated using MMS is rising steadily. The size of lesions treated using MMS has decreased slightly over several decades, as has the number of stages of MMS taken per lesion. The majority of MMS performed by fellowship directors is for skin cancer on the face. Dermatologic surgeons perform most of their own reconstructions. Academic and private fellowship practice patterns are nearly identical.
  
  
  CONCLUSIONS
  ACMS-approved fellowship directors use MMS mainly for facial skin cancers, and they perform most of their own reconstructions. Practice patterns for most fellowship directors are similar. Private fellowships and academic fellowships are similar in scope and practice.
authors.affiliation: Fletcher Allen Health Care-University of Vermont College of Medicine, Burlington, USA.
authors.forename: Angela S
authors.initials: AS
authors.lastname: Casey
authors.forename: Caitlin E
authors.initials: CE
authors.lastname: Kennedy
authors.forename: Glenn D
authors.initials: GD
authors.lastname: Goldman
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D006801:Humans; D015580:Mohs Surgery / Q000706:statistics & numerical data* / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000601:surgery*; D011795:Surveys and Questionnaires; D014481:United States