title: Application of Mohs micrographic surgery appropriate-use criteria to skin cancers at a university health system.
abstract: BACKGROUND
  Mohs micrographic surgery (MMS) is an effective treatment for skin cancer. Until recently, it has been difficult to determine the percentage of skin cancers best treated with MMS. The appropriate-use criteria represents an opportunity to more accurately estimate this number.
  
  
  OBJECTIVE
  We sought to apply the appropriate-use criteria retrospectively to University of Virginia Health System skin cancers so as to determine the proportion that met appropriate use within 8 months.
  
  
  METHODS
  A list of all biopsy-proven skin cancers, excluding invasive melanoma, at the University of Virginia Health System during an 8-month period was generated. Patient and tumor data were collected retrospectively from hospital records and each skin cancer was classified as appropriate, inappropriate, or uncertain based on the appropriate-use criteria.
  
  
  RESULTS
  Among 1059 skin cancers, MMS was appropriate in 72.0% of cases, inappropriate in 20.4%, and uncertain in 7.6%. Altogether, 59.3% of skin cancers occurred in H and M areas, which include the head, neck, hands, feet, ankles, genitalia, nipples/areola, and pretibial surface.
  
  
  CONCLUSIONS
  Patient and tumor information was collected retrospectively at 1 institution.
  
  
  CONCLUSIONS
  Using recently published appropriate-use criteria, 72.0% of skin cancers at this institution were appropriate for MMS. Tumor location was the most important factor in determining appropriate use.
authors.affiliation: Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Blechman
authors.affiliation: Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia; Department of Pathology, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: James W
authors.initials: JW
authors.lastname: Patterson
authors.affiliation: Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia. Electronic address: Mr2h@virginia.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Russell
mesh_terms: D000046:Academic Medical Centers; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D003880:Dermatology / Q000592:standards*; D005153:Facial Neoplasms / Q000473:pathology / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery; D006801:Humans; D015580:Mohs Surgery / Q000592:standards / Q000706:statistics & numerical data*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D000077195:Squamous Cell Carcinoma of Head and Neck; D014768:Virginia
keywords: Mohs micrographic surgery; appropriate-use criteria; skin cancer