Why appropriate use criteria for Mohs micrographic surgery?

Abstract

T he Boards of the American Academy of Dermatology, the American College of Mohs Surgery, theAmerican Society forDermatologic Surgery Association, and the American Society for Mohs Surgery recently approved the extraordinary work of the Mohs Surgery Appropriate Use Criteria (AUC) Ad Hoc Task Force chaired by Dr Suzanne Connolly. The AUC are published in this edition of the Journal of theAmericanAcademy ofDermatology and concurrently in Dermatologic Surgery, and serve as a decisive statement for the proper use of Mohs micrographic surgery; theywill bean invaluable resource for all ethical Mohs surgeons. The success of this document is underscored by the wide breadth of individuals involved in its development, including Mohs surgeons, medical dermatologists, and dermatopathologists from across the country, representing both academic and private practice. Importantly, the majority of the ratings panelists were not Mohs surgeons. The use of Mohs micrographic surgery for skin cancer has grown dramatically in the past 15 years, from approximately 1 in 20 skin cancers to approximately 1 in 4. This is partially a result of the skin cancer epidemic, and partially a result of the increase in the numbers of dermatologists who practice Mohs micrographic surgery, which increases the availability and treatment option of this technique. There were many very good reasons to develop these AUC. Although the availability of Mohs micrographic surgery has undoubtedly benefited patients who have skin cancer, there has been backlash at the federal level and by other third-party payers as use and the associated cost of the procedure has attracted notice.Any rapid increase inuse is often automatically and incorrectly assumed to indicate that a procedure is overvalued. There is no recognition or allowance in