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    How to weigh benefit of Moh's

    New tools help dermatologists weigh when surgery is warranted

    Whether a skin cancer patient is or isn’t a good candidate for Mohs isn’t always clear cut.

     A panel of experienced Mohs surgeons tackled the topic “To Mohs or not to Mohs,” during the American Academy of Dermatology Summer Scientific Sessions in Boston. The panel’s director Richard Gary Bennett, M.D., clinical professor of medicine (dermatology), UCLA, and clinical professor of dermatology at University of Southern California (USC), says there is an important new document that helps dermatologists in their decision making.

     Richard Gary Bennett, M.D.Dr. Bennett“There are guidelines1 for Mohs surgery … developed by the American Academy of Dermatology in conjunction with the American Society for Dermatologic Surgery. And those guidelines basically try to quantitate, if you will, what the appropriateness of doing Mohs surgery is in certain case scenarios,” Dr. Bennett says.

     The production and adoption of these first Mohs guidelines by the AAD and ASDS started about four years ago, according to Suzanne Olbricht, M.D., chair of dermatology at Lahey Hospital and Medical Center, Burlington, Mass., incoming president elect of the American Academy of Dermatology and a panel member at this session at the AAD’s summer meeting. The Mohs guidelines’ authors used a modified RAND/UCLA Appropriateness Method to develop appropriate use criteria for basal and squamous cell skin cancers. To accompany the desk top document, there is a "Mohs Surgery Appropriate Use Criteria" app, which dermatologists and others can access on their mobile devices.

    The interactive app2, with free download, offers decision support on Mohs appropriateness in 270 scenarios, color-coded body maps for low- to high-risk areas and more. Doctors can enter the tumor type, size and other information to get an appropriateness score.

     A tool; not the rule

     As helpful as the guidelines and app are, they are not the end-all of decision making, according to Dr. Bennett.

     “The case scenarios [in the guidelines] are not totally inclusive,” Dr. Bennett says.

     Among the important issues the guidelines do not address are age or skin cancer patients’ comorbidities, he says.

     In real world practice, that means Mohs surgery might not benefit a 98-year-old patient with a basal cell on his nose; whereas, it will likely benefit a 30-year-old with the same cancer diagnosis. And, while the high cure rate of Mohs will likely be in an otherwise healthy patient’s best interests, that might not the case for a patient who has only a year or two to live, according to Dr. Bennett.

    Next: Making the decision

    Lisette Hilton
    Lisette Hilton is president of Words Come Alive, based in Boca Raton, Florida.

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