Association Between Number of Stages in Mohs Micrographic Surgery and Surgeon-, Patient-, and Tumor-Specific Features: A Cross-Sectional Study of Practice Patterns of 20 Early- and Mid-Career Mohs Surgeons

Abstract

Early- and mid-career Mohs surgeons appear to remove tumors with similar numbers of stages regardless of their experience, case volume, or geographic location. Number of stages varies with anatomic location and tumor type. The authors have indicated no significant interest with commercial supporters.

Factors predictive of complex Mohs surgery cases

“…Moreover, it is not uncommon for an individual Mohs surgeon to transition between working in either an academic or private practice setting during his/her career. In another recent cross-sectional survey of 20 Mohs surgeons who completed fellowship within the last 10 years, no significant differences were found in mean stage number for those in practice for 1-5 years (1.93 stages per case) compared with those in practice for 6-11 years (1.7 stages per case; p = 0.23) (4).…”

Mohs micrographic surgery for basal cell carcinomas: appropriateness of ‘Rotterdam’ criteria and predictive factors for three or more stages

“…However, after adjusting for H‐zone location in the multivariate analyses, the other indication criteria associated with three or more stages remained significant, indicating that H‐zone was not a confounder. Therefore, another explanation could be that the H‐zone, which includes embryonic fusion planes, offers a path of least resistance for the early development of vertical invasion and lateral spread of tumours located in this area, hereby enhancing the risk on extensive subclinical tumour spread 27,28 …”

Tumor Detection After Inflammation or Fibrosis on Mohs Levels

“…The most common tumors treated with MMS are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Ninety‐eight percent of lesions are cleared in four or fewer stages, although at least two are commonly required . Many surgeons will take an additional level based solely on the presence of inflammation or fibrosis.…”

“…Ninety-eight percent of lesions are cleared in four or fewer stages, although at least two are commonly required. 4 Many surgeons will take an additional level based solely on the presence of inflammation or fibrosis. We are not aware of any studies examining how frequently tumor is detected in subsequent levels.…”