By Allison T. Vidimos, RPh, MD
In 2012, after the first appropriate use criteria (AUC) on Mohs micrographic surgery was published in the Journal of the American Academy of Dermatology (JAAD) and Dermatologic Surgery, I made copies of the Mohs AUC evidence tables and posted them in our staff charting room — all five pages of them, as well as a sixth page with a summary of the ratings categories by tumor type.
“Is this new wallpaper?” a colleague asked in bewilderment.
“No, these are the Mohs surgery AUC evidence tables,” I explained. “They are very important! Everyone needs to review them.” The fine-print tables were admittedly a challenge to digest and use, and left us both a bit blurry-eyed.
How were the AUC developed?
The Academy’s Ad Hoc Task Force (AHTF) for Appropriate Use Criteria for Mohs Surgery, composed of nine members representing the AAD, American College of Mohs Surgery (ACMS), American Society for Dermatologic Surgery Association (ASDSA) and American Society for Mohs Surgery (ASMS), developed the Mohs surgery AUC by starting with development of clinical scenarios.
A review panel edited these clinical scenarios, which were then given to a ratings panel that was comprised of a mix of clinical and surgical dermatologists from academic and private practices from across the country.
Evidence-based data were compiled by surgical fellows who abstracted information from more than 400 peer-reviewed articles about Mohs surgery for a variety of skin cancers. The ratings panel used these data to grade the indication for Mohs surgery for each clinical scenario as appropriate, inappropriate, or uncertain.
After an 18-month gestation period — and the hard work of more than 75 physicians —the Mohs surgery AUC was born.
However, as noted above, distilling the information from the fine print tables in the AUC article and putting it into practice was a challenge. So, we asked the Academy to provide physicians with an easy reference tool that would facilitate this important process.
The result is the new Mohs Surgery Appropriate Use Criteria App. This app allows you to easily and systematically determine when Mohs surgery is most appropriate for your patients from your mobile Apple device, right at the point of care.
As one of the physicians that the Academy enlisted to review the app during the development process, I was asked to take a test drive of the product — which was released earlier this month — and report on how it performs in a practice setting.
What does the app do?
In a nutshell, the app saves you the hassle of reading a 20-page paper in a peer-reviewed journal and memorizing the treatment algorithms. It leads you through a simple process of selecting skin cancer type, location, recurrent or primary, histologic features, tumor size, and patient characteristics (healthy, immunocompromised, or genetic syndrome). After referring to 270 unique scenarios based on scientific evidence, the app offers up an answer in seconds. On a median scale of one to nine, the app lets you know whether Mohs surgery has been rated as appropriate, not appropriate, or uncertain for your specific clinical scenario. If the result is uncertain, it means that there is not enough evidence in literature to support whether it’s appropriate.
Why do physicians need this app?
The app is a very easy way to determine a skin cancer’s appropriateness for Mohs surgery versus other options for treatment. Instead of having to remember all the tumor types, sizes, or high-risk locations and features, this app does it for you. It has all of the evidence-based AUC data programmed into it, which has been fully vetted by a team of physicians.
What are the app’s best features?
The beauty of the app is that’s so simple to use. It walks physicians through each data point and produces an answer in seconds based on available scientific evidence.
Oh, and did I mention that it’s free? Download it at no charge on your iPhone or iPad from the Apple Store.
Can I use it in front of patients?
The app is an excellent educational tool, so it is very valuable in helping patients understand the reasons about whether to perform Mohs surgery. I often get patients who insist on getting Mohs surgery for every skin cancer, high risk or not. When I punch in their particular scenarios into the app and show them that Mohs surgery isn’t necessarily indicated, it makes the patients more confident in other treatment options.
Would you recommend it to physicians outside the specialty?
I encourage dermatologists to recommend the app to colleagues in other disciplines. Most dermatologists can easily gauge whether a tumor is worrisome or high risk. However, physicians outside the specialty would greatly benefit from this diagnostic app, because it can help them determine whether to refer a patient to a dermatologist for Mohs surgery or another procedure.
Download the app now!
Allison T. Vidimos, RPh, MD, is chairman of the Department of Dermatology and staff physician in the Section of Micrographic Surgery (Mohs) and Oncology at the Cleveland Clinic, and professor at the Cleveland Clinic Lerner College of Medicine. She is also the program director of the Procedural Dermatology Fellowship. Dr. Vidimos served as a member of the Academy’s Ad Hoc Task Force for the Development of Mohs Appropriate Use Criteria and has also participated as a speaker during educational sessions regarding the Mohs AUC at the Academy’s 2013 and 2014 Annual Meetings. She also served on a physician panel that reviewed the app during development and provided helpful feedback about its layout and utility in the practice setting.
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