Reevaluating Mohs Surgery Appropriate Use Criteria for Primary Superficial Basal Cell Carcinoma

Mohs Appropriate Use Criteria for Superficial Basal Cell Carcinoma

“…Again, by way of comparison with the current histopathologic pathway using a 7% prevalence, the calculated NPV from Elmore et al 5 for early-stage melanoma based on the sensitivity described herein is well below 83%. 1,4,5 It is also important to note that 708 PLAevaluated real-world lesions have now been followed up for over a year, and no missed melanomas have been identified (D.M.S. and Laura K. Ferris, MD, PhD, unpublished observations), further supporting the high NPV of the PLA.…”

“…To the Editor We read with interest the Viewpoint by Steinman and colleagues 1 suggesting a reevaluation of appropriate use criteria for Mohs micrographic surgery (MMS) with respect to primary superficial basal cell carcinoma (sBCC). We must note that MMS is only 1 means of margin control of skin cancers, and perhaps the Viewpoint title would more accurately read "Reevaluation of Excisional Surgery for Primary Basal Cell Carcinoma.…”

“…While we found noncited studies claiming that twice-daily application of imiquimod has demonstrated 100% clearance at 6 weeks after therapy, other studies have not been as positive, demonstrating clearance rates of 77.9% to 80.4% at 5-year followup-a stark contrast with the 1% recurrence rate for primary BCC managed with MMS. 2 The majority of tumors evaluated by Steinman and colleagues 1 were located on the trunk and extremities. Moreover, imiquimod treatment of nodular BCC and sBCC has demonstrated 82.5% success compared with 97.7% success with surgical excision (with 4-mm margins) at 5-year follow-up in a randomized clinical trial of 401 participants.…”

“…This in turn drives cost savings for the health care system (−47% at the PLA selling price reference point of $500) and demonstrates that the PLA is a new technology that can deliver better care at a lower cost. [1][2][3][4]…”

Discrepancies in the Mohs Micrographic Surgery appropriate use criteria

“…Notably, Steinman et al scrutinize the classification of most primary superficial basal cell carcinomas (BCCs) as appropriate for treatment by MMS. 2 The authors argue that primary superficial BCCs are associated with comparable cure rates when treated by MMS or curettage and cryosurgery, are often multifocal and require more Mohs stages than other BCC subtypes, and largely lack data on risk for recurrence and invasion. Kelleners-Smeets et al further scrutinize the report's limitation that only publications from the United States are included, omitting several elucidating European trials.…”