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Mohs Surgery and Excision: Comparing the Costs

Perceptions about the relative costs of MMS and traditional excision may need adjusting.

Mohs micrographic surgery (MMS) achieves the highest cure rate for nonmelanoma skin cancer (NMSC) but is perceived to be more expensive than other treatments. These authors performed a prospective cost analysis of Mohs surgery and traditional excision. Ninety-eight consecutive patients with a primary diagnosis of NMSC of the face or ear underwent MMS followed by reconstruction or second-intention healing, as deemed appropriate by the surgeon, in an office setting. Before surgery, an ENT surgeon examined the lesion and outlined an alternative treatment plan, including proposed excision and reconstruction techniques; frozen-section use, if any; and operative setting. The authors used Connecticut Medicare allowables data for 2002 to compare costs, taking multiple procedure and facility reductions into account. If the actual MMS margins extended past the proposed margins of the standard excision, the authors assumed that extra excision and further examination using frozen or permanent sections or subsequent MMS would have been performed.

The mean cost of MMS with repair or granulation was $937; the mean cost of the proposed standard excision with repair was significantly lower ($831). This cost, however, did not include further procedures for positive margins, which would have occurred in 32% of the proposed scenarios. Had the additional treatment been MMS, costs would have increased to $1029. Had the margins been re-excised and processed with permanent sections, the price would have risen to $944, about the cost of the original MMS. The most expensive option was excision with frozen sections and repair in an ambulatory surgery center (mean, $1399); the second most expensive was excision with positive margins treated by subsequent MMS and repair (mean, $1110). The choice of reconstructive technique had a significant impact on cost.

Comment: MMS and repair is less expensive than excision and repair with frozen sections and costs about the same as excision and repair with permanent sections performed by an ENT surgeon. These findings underestimated the cost of standard excision by ignoring the cost of managing late recurrences (which can be expected in 5%-10% of cases) and the need for more than one re-excision in patients with positive margins. Based on these and earlier findings, NMSC treatment procedures can be ranked by cost as follows (lowest to highest): cryosurgery, electrodesiccation and curettage, excision with permanent sections in the office, MMS, excision with frozen sections in an ambulatory surgery center or operating room, and x-ray treatment.

— George J. Hruza, MD

Published in Journal Watch Dermatology June 30, 2004

Citation(s):

Bialy TL et al. Mohs micrographic surgery vs traditional surgical excision: A cost comparison analysis. Arch Dermatol 2004 Jun; 140:736-42.

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