title: Mohs appropriate use criteria: retrospectively applied to nonmelanoma skin cancers at a single academic center.
abstract: BACKGROUND
  In September 2012, appropriate use criteria (AUC) for Mohs micrographic surgery (MMS) were released by a collaboration of dermatology organizations including the American College of Mohs Surgery.
  
  
  OBJECTIVE
  The group sought to determine adherence to the Mohs AUC at the academic institution.
  
  
  METHODS
  The authors performed a retrospective chart review of all nonmelanoma skin cancers (NMSCs) treated within the University of Utah, Department of Dermatology, from January through March of 2012. They applied the Mohs AUC to analyze these cases.
  
  
  RESULTS
  In total, the authors identified 724 patients and 1,026 cases of NMSCs, including 557 (54.3%) basal cell carcinomas and 469 (45.7%) squamous cell carcinomas. Of the 1,026 NMSCs, 350 (34.1%) were treated with MMS. Of these cases treated with MMS, there were 339 cases (96.9%) deemed appropriate, 4 (1.1%) uncertain, and 7 (2.0%) inappropriate per AUC. Also examined were 611 cases treated with modalities other than MMS, of which 60.7% would have met AUC for MMS.
  
  
  CONCLUSIONS
  In a 3-month review of all NMSC cases at the academic center, there is a low percentage of cases performed that are inappropriate for MMS by AUC. At the institution, there is a large percentage of NMSC that meet AUC but are treated by other modalities. The use is highly appropriate for MMS, and these data suggest possible underutilization of MMS for certain NMSCs. Further studies are required to determine the effectiveness of other treatment modalities for NMSC that meet Mohs AUC.
authors.affiliation: *Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah; †Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah.
authors.forename: Tracie
authors.initials: T
authors.lastname: Chong
authors.forename: Payam
authors.initials: P
authors.lastname: Tristani-Firouzi
authors.forename: Glen M
authors.initials: GM
authors.lastname: Bowen
authors.forename: Michael L
authors.initials: ML
authors.lastname: Hadley
authors.forename: Keith L
authors.initials: KL
authors.lastname: Duffy
mesh_terms: D000368:Aged; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D015580:Mohs Surgery / Q000706:statistics & numerical data*; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*