Mohs Surgery Gains Popularity Among Older Patients

Mohs micrographic surgery (MMS) for the treatment of nonmelanoma skin cancer (NMSC) has doubled in the past decade, particularly among patients in their 60’s.

Researchers at the Albert Einstein College of Medicine (New York, NY, USA), the Yale Comprehensive Cancer Center (New Haven, CT, USA), and other institutions conducted a retrospective analysis of Medicare beneficiaries to identify Medicare use rates of MMS and surgical excision for the treatment of NMSC from January 1, 2001, through December 31, 2006. The main outcome measures were surgical treatment, patient, and lesion characteristics associated with treatment type.

The results showed that a total of 26,931 operations were performed for the treatment of NMSC during the study period, of which 36.4% were MMS. Although the rate of surgical excision slightly increased during this period, the rate of MMS doubled. MMS was performed in 46.9% of facial lesions, whereas it was only used to treat 14.7% of total body lesions. The researchers found that age, race, lesion location, and area of country for patient treatment were significantly associated with MMS use; 40.6% of patients aged 67 to 69 underwent Mohs surgery, while among those 85 and older, the percentage was only 33.5%.

Atlanta (GA, USA) had the highest proportion of patients treated with MMS (45.1%); the state of Louisiana had the lowest (11%). High rates were also seen in Detroit (MI), Los Angeles (CA), Iowa, and New Jersey. Among the possible reasons for geographic variation cited by the researchers were sun exposure, higher proportions of elderly in the population, and the presence of academic medical centers with specialized facilities. The study was published in the April 2012 issue of Archives of Dermatology.

“We hypothesize that younger patients and their physicians may be more concerned with cosmetic outcome, tissue preservation, and minimizing recurrence compared with older individuals, who may have comorbidities or other medical needs in which Mohs micrographic surgery would not be an appropriate treatment option,” concluded Cary Gross, MD, of Yale, and colleagues.

MMS is a surgical technique for the removal of skin carcinomas that allows precise microscopic marginal control by using horizontal frozen sections. For example, MMS has become the treatment of choice for basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) at high risk for local recurrence. The advantages of the technique include superior cure rates, maximal tissue conservation, ability to trace perineural or infiltrating tumors histologically, low cost relative to that of radiation therapy, excision, or surgery, and negligible risk of complications from general anesthesia.

Related Links:
Albert Einstein College of Medicine
Yale Comprehensive Cancer Center