Nov 21, 2019
Mohs micrographic surgery (MMS) entails many
controversies – from specialty certification to the types
of tumors treated. Three dermatology residents – Dr. Julie Croley,
Dr. Elisabeth Tracey, and Dr. Daniel Mazori – discuss MMS for
melanoma and other tumors as well as reimbursement for and the
cost-effectiveness of the procedure. They also highlight
controversies surrounding the Mohs Appropriate Use Criteria (AUC).
“It appears further investigation is needed to elucidate and
optimize solutions to many of the current controversies associated
with Mohs micrographic surgery,” Dr. Croley says.
* * *
Help us make this podcast better! Please take
our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019
Are you a fan of our podcast? Recommend it to a friend on
Twitter by tagging @MDedgeDerm, and we’ll
give you a shout out in our next episode.
We bring you the latest in dermatology news and
Apremilast for Behçet’s oral ulcers: Benefits maintained at 64
Reassuring results of a long-term extension
of the phase 3 RELIEF trial.
Melanoma incidence drops in younger age groups
Fewer teens and young adults developed melanoma between 2006 and
2015, while incidence increased in older adults.
In Oregon, ‘war on melanoma’ takes flight
A research project hopes to shrink melanoma mortality by
emphasizing education, screening.
Things you will learn in this episode:
- The 5-year survival in metastatic rates for melanomas treated
with Mohs micrographic surgery (MMS) with frozen sections were the
same or better when compared with historical controls treated with
conventional wide local excision.
- Immunostaining in melanoma may improve accuracy but includes
many challenges: It is time-consuming, reagents can be costly and
could expire, some cases are equivocal, clinicians’ exposure to
immunostaining education is limited, and training is required to
interpret margins. “So there are a lot of barriers to using
immunostaining,” Dr. Croley says, “but I think it has a lot of
potential in the future.”
- Utilization of MMS has increased in recent years, possibly due
to superior efficacy for appropriately chosen cases and it is being
expanded to treat other tumors such a melanoma and Merkel cell
- There is wide variation in mean number of Mohs stages among
dermatologic surgeons. Mailing out individual reports of practice
patterns to high-outlier physicians resulted in a reduction in mean
stages per tumor as well as an associated cost savings when
compared with outlier physicians who did not receive these
- Codes for MMS are frequently reviewed by a Relative Value Scale
Update Committee, and the procedure is listed as a potentially
misvalued service according to the Centers for Medicare &
Medicaid Services. “Reimbursements for Mohs surgery and
reconstructive surgery have gone down by more than 20% in the last
15 years – at least, in part, as a result of this scrutiny,” Dr.
- Mohs AUC has been criticized for classifying most primary
superficial basal cell carcinomas as appropriate for MMS and for
not considering variables such as operating on multiple tumors on
the same day and operating on a tumor that is incorporating into an
- Specialty certification in MMS has been a split issue.
“Proponents have argued that certification could bring more
consistency and decrease divisiveness among dermatologists,” Dr.
Mazori says. “Opponents of certification have argued that it could
disenfranchise many dermatologists.”
Hosts: Elizabeth Mechcatie, Terry Rudd
Julie Ann Amthor Croley, MD (University of Texas Medical Branch
at Galveston); Elisabeth
(Libby) Tracey, MD (Cleveland Clinic Foundation);
Daniel R. Mazori, MD (State University of New York,
Show notes by: Jason Orszt, Melissa Sears,
For more MDedge Podcasts, go to
Email the show: firstname.lastname@example.org
Interact with us on Twitter: @MDedgeDerm