AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery

A report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery

Suzanne M. Connolly, Diane R. Baker, Brett M. Coldiron, Michael J. Fazio, Paul A. Storrs, Allison T. Vidimos, Mark J. Zalla, Jerry D. Brewer, Wendy Smith Begolka, Timothy G. Berger, Michael Bigby, Jean L. Bolognia, David G. Brodland, Scott Collins, Terrence A. Cronin, Mark V. Dahl, Jane M. Grant-Kels, C. William Hanke, George J. Hruza, William D. James & 6 others Clifford Warren Lober, Elizabeth I. McBurney, Scott A. Norton, Randall K. Roenigk, Ronald G. Wheeland, Oliver J. Wisco

Research output: Contribution to journalArticle

177 Citations (Scopus)

Abstract

The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate use criteria for 270 scenarios for which Mohs micrographic surgery (MMS) is frequently considered based on tumor and patient characteristics. This document reflects the rating of appropriateness of MMS for each of these clinical scenarios by a ratings panel in a process based on the appropriateness method developed by the RAND Corp (Santa Monica, CA)/University of California-Los Angeles (RAND/UCLA). At the conclusion of the rating process, consensus was reached for all 270 (100%) scenarios by the Ratings Panel, with 200 (74.07%) deemed as appropriate, 24 (8.89%) as uncertain, and 46 (17.04%) as inappropriate. For the 69 basal cell carcinoma scenarios, 53 were deemed appropriate, 6 uncertain, and 10 inappropriate. For the 143 squamous cell carcinoma scenarios, 102 were deemed appropriate, 7 uncertain, and 34 inappropriate. For the 12 lentigo maligna and melanoma in situ scenarios, 10 were deemed appropriate, 2 uncertain, and 0 inappropriate. For the 46 rare cutaneous malignancies scenarios, 35 were deemed appropriate, 9 uncertain, and 2 inappropriate. These appropriate use criteria have the potential to impact health care delivery, reimbursement policy, and physician decision making on patient selection for MMS, and aim to optimize the use of MMS for scenarios in which the expected clinical benefit is anticipated to be the greatest. In addition, recognition of those scenarios rated as uncertain facilitates an understanding of areas that would benefit from further research. Each clinical scenario identified in this document is crafted for the average patient and not the exception. Thus, the ultimate decision regarding the appropriateness of MMS should be determined by the expertise and clinical experience of the physician.

Original languageEnglish (US)
Pages (from-to)531-550
Number of pages20
JournalJournal of the American Academy of Dermatology
Volume67
Issue number4
DOIs
StatePublished - Oct 2012

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Mohs Surgery
Dermatologic Surgical Procedures
Hutchinson's Melanotic Freckle
Physicians
Los Angeles
Evidence-Based Medicine
Basal Cell Carcinoma
Patient Selection
Squamous Cell Carcinoma
Melanoma
Neoplasms
Consensus
Decision Making
Delivery of Health Care
Skin
Research

Keywords

  • appropriate use criteria
  • dermatology
  • lentigo maligna
  • melanoma in situ
  • Mohs micrographic surgery
  • nonmelanoma skin cancer

ASJC Scopus subject areas

  • Dermatology

Cite this

AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery : A report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery. / Connolly, Suzanne M.; Baker, Diane R.; Coldiron, Brett M.; Fazio, Michael J.; Storrs, Paul A.; Vidimos, Allison T.; Zalla, Mark J.; Brewer, Jerry D.; Smith Begolka, Wendy; Berger, Timothy G.; Bigby, Michael; Bolognia, Jean L.; Brodland, David G.; Collins, Scott; Cronin, Terrence A.; Dahl, Mark V.; Grant-Kels, Jane M.; Hanke, C. William; Hruza, George J.; James, William D.; Lober, Clifford Warren; McBurney, Elizabeth I.; Norton, Scott A.; Roenigk, Randall K.; Wheeland, Ronald G.; Wisco, Oliver J.

In: Journal of the American Academy of Dermatology, Vol. 67, No. 4, 10.2012, p. 531-550.

Research output: Contribution to journalArticle

Connolly, SM, Baker, DR, Coldiron, BM, Fazio, MJ, Storrs, PA, Vidimos, AT, Zalla, MJ, Brewer, JD, Smith Begolka, W, Berger, TG, Bigby, M, Bolognia, JL, Brodland, DG, Collins, S, Cronin, TA, Dahl, MV, Grant-Kels, JM, Hanke, CW, Hruza, GJ, James, WD, Lober, CW, McBurney, EI, Norton, SA, Roenigk, RK, Wheeland, RG & Wisco, OJ 2012, 'AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: A report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery', Journal of the American Academy of Dermatology, vol. 67, no. 4, pp. 531-550. https://doi.org/10.1016/j.jaad.2012.06.009
Connolly, Suzanne M. ; Baker, Diane R. ; Coldiron, Brett M. ; Fazio, Michael J. ; Storrs, Paul A. ; Vidimos, Allison T. ; Zalla, Mark J. ; Brewer, Jerry D. ; Smith Begolka, Wendy ; Berger, Timothy G. ; Bigby, Michael ; Bolognia, Jean L. ; Brodland, David G. ; Collins, Scott ; Cronin, Terrence A. ; Dahl, Mark V. ; Grant-Kels, Jane M. ; Hanke, C. William ; Hruza, George J. ; James, William D. ; Lober, Clifford Warren ; McBurney, Elizabeth I. ; Norton, Scott A. ; Roenigk, Randall K. ; Wheeland, Ronald G. ; Wisco, Oliver J. / AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery : A report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery. In: Journal of the American Academy of Dermatology. 2012 ; Vol. 67, No. 4. pp. 531-550.
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abstract = "The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate use criteria for 270 scenarios for which Mohs micrographic surgery (MMS) is frequently considered based on tumor and patient characteristics. This document reflects the rating of appropriateness of MMS for each of these clinical scenarios by a ratings panel in a process based on the appropriateness method developed by the RAND Corp (Santa Monica, CA)/University of California-Los Angeles (RAND/UCLA). At the conclusion of the rating process, consensus was reached for all 270 (100{\%}) scenarios by the Ratings Panel, with 200 (74.07{\%}) deemed as appropriate, 24 (8.89{\%}) as uncertain, and 46 (17.04{\%}) as inappropriate. For the 69 basal cell carcinoma scenarios, 53 were deemed appropriate, 6 uncertain, and 10 inappropriate. For the 143 squamous cell carcinoma scenarios, 102 were deemed appropriate, 7 uncertain, and 34 inappropriate. For the 12 lentigo maligna and melanoma in situ scenarios, 10 were deemed appropriate, 2 uncertain, and 0 inappropriate. For the 46 rare cutaneous malignancies scenarios, 35 were deemed appropriate, 9 uncertain, and 2 inappropriate. These appropriate use criteria have the potential to impact health care delivery, reimbursement policy, and physician decision making on patient selection for MMS, and aim to optimize the use of MMS for scenarios in which the expected clinical benefit is anticipated to be the greatest. In addition, recognition of those scenarios rated as uncertain facilitates an understanding of areas that would benefit from further research. Each clinical scenario identified in this document is crafted for the average patient and not the exception. Thus, the ultimate decision regarding the appropriateness of MMS should be determined by the expertise and clinical experience of the physician.",
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