Mohs Appropriate Use Criteria Scores and Treatment of Keratinocyte Carcinoma: Review of 11,145 Tumors

Abstract

Background: Various methods are available for treatment of keratinocyte carcinomas (KCs). The Mohs appropriate use criteria (AUC) score was developed to quantify the appropriateness of Mohs micrographic surgery (MMS) based on multiple tumor and patient characteristics. Objectives: Stratify KCs by treatment modality used and compare to Mohs AUC score. Methods: Conducted a retrospective review of 11,145 consecutive KCs between 01/2017 and 12/2021, comparing associated Mohs AUC score with modality selected. Results: The average Mohs AUC score for all KCs combined was 7.1 with 8714 (78.2%) qualifying for MMS via AUC score. However, MMS was only done on 2813 (32.3%) of KCs. Excisional surgery was used to treat 4580 (41.1%) of KCs, 2777 (24.9%) were treated with electrodesiccation and curettage (ED&C), and 732 (6.6%) were treated with biopsy only. Of those KCs treated with excision, ED&C, or a biopsy, 70.7%, 70.7%, and 72.4% reached an “appropriate” Mohs AUC score for MMS respectively. Limitations: This is a single private practice, with two board certified dermatologists Conclusions: Mohs AUC score can help determine if a KC warrants MMS; however, in our practice, MMS was necessary for only 32.3% of the KCs that qualified based on the Mohs AUC score.