Appropriate use criteria for Mohs micrographic surgery


This report addresses the appropriate use of Mohs micrographic surgery (MMS) in the treatment of cutaneous neoplasms. In the United States in 2006, 

There were an estimated 3.5 million nonmelanoma skin cancers diagnosed, and it is projected that there will be nearly 4 million new cases of nonmelanoma skin cancer diagnosed in the United States each year.1 Similarly, the incidence of melanoma in situ continues to increase with an estimated 55,560 to be newly diagnosed in 2012,2 with many of these likely to be of the lentigo maligna (LM) subtype.3

Because of this epidemic of skin cancer and an increase in the number of dermatologists trained in MMS, the use of this treatment modality has expanded significantly in recent years. In fact, the use of MMS increased by 400% from 1995 to 2009, and currently 1 in 4 skin cancers is being treated with MMS.4 As the incidence of skin cancer continues to climb and the field of MMS continues to advance, dermatologists, primary care providers, Mohs surgeons, and the health care community in general will need to understand how to best use MMS in the treatment of skin cancer.

This appropriate use criteria (AUC) document from the American Academy of Dermatology (AAD), American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and American Society for Mohs Surgery reflects an ongoing effort to systematically review and categorize the appropri- ate use of MMS. This publication is not a comparative document of different modalities used to treat cutane- ous malignancy, but a document that pertains solely to the use of MMS and the appropriateness of MMS in certain clinical scenarios. It is thus important to understand the background and scope of this publi- cation before interpreting the rating tables.