title: Tumor recurrence of keratinocyte carcinomas judged appropriate for Mohs micrographic surgery using Appropriate Use Criteria.
abstract: BACKGROUND
  The use of Mohs micrographic surgery (MMS) has increased greatly to treat basal cell and cutaneous squamous cell carcinomas (keratinocyte carcinoma [KC]), and consensus-based Appropriate Use Criteria (AUC) were developed to identify tumors for which MMS is appropriate.
  
  
  OBJECTIVE
  We sought to compare recurrence rates after different treatments in tumors judged appropriate for MMS.
  
  
  METHODS
  We used data from an observational prospective cohort study and retrospectively categorized consecutive tumors as appropriate for MMS according to the AUC. Among appropriate tumors, we used survival analyses to compare 5-year recurrence rates after treatments.
  
  
  RESULTS
  Among tumors appropriate for MMS (N = 1483), adjusted 5-year recurrence rates were 2.9% (range, 1.4-4.3%) after MMS, 5.5% (range, 3.1-7.9%) after excision, 4.0% (range, 0.6-7.2%) after destruction, and 5.9% (range, 1.5-10.2%) after other treatments. In tumors treated only with MMS or excision (the most similar subgroups), the adjusted hazard ratio of 5-year recurrence after MMS was 0.6 (95% confidence interval, 0.3-1.0; P = .06).
  
  
  CONCLUSIONS
  This study is limited by its uncertain generalizability, lack of randomization, and unmeasured characteristics.
  
  
  CONCLUSIONS
  The AUC identified tumors for which recurrence would be less common after MMS than after excision, but the absolute difference in recurrence rates was small.
authors.affiliation: Department of Dermatology (Program for Clinical Research), University of California, San Francisco, CA; College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Stuart
authors.affiliation: Department of Dermatology (Program for Clinical Research), University of California, San Francisco, CA; Population Services International, Washington, DC.
authors.forename: Patrick
authors.initials: P
authors.lastname: Schoen
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
authors.forename: Chengshi
authors.initials: C
authors.lastname: Jin
authors.affiliation: Department of Dermatology (Program for Clinical Research), University of California, San Francisco, CA; Cardiovascular Research Foundation, New York, New York.
authors.forename: Rupa
authors.initials: R
authors.lastname: Parvataneni
authors.affiliation: Department of Dermatology (Program for Clinical Research), University of California, San Francisco, CA; San Francisco Veterans Affairs Medical Center, San Francisco, CA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Arron
authors.affiliation: Department of Dermatology (Program for Clinical Research), University of California, San Francisco, CA.
authors.forename: Eleni
authors.initials: E
authors.lastname: Linos
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, CA; Department of Medicine, University of California, San Francisco, CA.
authors.forename: W John
authors.initials: WJ
authors.lastname: Boscardin
authors.affiliation: Department of Dermatology (Program for Clinical Research), University of California, San Francisco, CA; San Francisco Veterans Affairs Medical Center, San Francisco, CA. Electronic address: chrenm@derm.ucsf.edu.
authors.forename: Mary-Margaret
authors.initials: MM
authors.lastname: Chren
mesh_terms: D000368:Aged; D002280:Basal Cell Carcinoma / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D015580:Mohs Surgery; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000601:surgery*; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000601:surgery*
keywords: Appropriate Use Criteria; Mohs micrographic surgery; basal cell carcinoma; cutaneous squamous cell carcinoma; keratinocyte carcinoma; outcomes research