Mohs Most Cost-Effective Treatment for Skin Cancer

Yael Waknine

April 03, 2012

April 3, 2012 — Mohs micrographic surgery (MMS) represents the most cost-effective treatment for skin cancer, according to an article published online March 22 and in the April print issue of Dermatologic Surgery.

MMS is a method of excising a tumor and the surrounding skin with the help of a microscope, allowing the dermatologic surgeon to trace the outline of a cancerous growth, layer by layer, with exceptional accuracy. The method is associated with significant tissue sparing, resulting in smaller simpler repairs or an option to let the wound heal by secondary intention.

Investigators led by Larisa Ravitskiy, MD, from the Ohio Skin Cancer Institute at Ohio State University in Columbus, performed a cost analysis with respect to 406 tumors that were cleared with a mean of 1.6 stages (range, 1 - 8 stages). The expenses related to subsequent re-excision and reconstruction and tumor recurrence were added to the final estimate.

Results showed that MMS was the least expensive of surgical options ($805/tumor) compared with standard surgical excision (SSE) with permanent margins ($1026), SSE with frozen margins ($1200), and SSE performed in an ambulatory surgery center ($2507).

"The common misperception of MMS as an expensive option has its roots in the poorly understood bundled reimbursement of the procedure, which includes costs of surgical excision, histology preparation, and pathology," the authors write, noting the increased use of MMS in an aging population with a greater incidence of skin cancer.

In fact, the cost of MMS when adjusted for inflation (including initial exam, biopsy, and 5-year follow-up) was lower in 2009 than in 1998 ($1376 vs $1635).

The authors suggest that clinicians should be aware that MMS offers low recurrence rates; smaller defects, resulting in simpler, less-costly repairs; and overall cost efficacy.

"Once the effect of MMS on economic savings and cure rates is recognized, restrictions on the use of MMS will be lifted. The cost and value inherent in MMS rightfully prioritize it as the treatment of choice for cutaneous malignancies," the authors conclude.

The authors have disclosed no relevant financial relationships.

Dermatol Surg. 2012;38:585-594. Abstract

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