First appropriate use criteria in dermatology released

SCHAUMBURG, Ill. (September 7, 2012) –Collaborative effort designed to identify best candidates for Mohs surgery in treating skin cancer

A new manuscript co-published in the Journal of the American Academy of Dermatology (JAAD) and Dermatologic Surgery outlines Appropriate Use Criteria (AUC) for Mohs surgery — the first AUC for any test or treatment within the field of dermatology. The Mohs AUC represents a collaborative initiative by the American Academy of Dermatology (Academy), American College of Mohs Surgery (ACMS), the American Society for Dermatologic Surgery Association (ASDSA), and the American Society for Mohs Surgery (ASMS). 

“These Appropriate Use Criteria for Mohs surgery embody a unique effort to develop criteria to support the efficient use of medical resources while providing the highest quality care for the patients who will benefit the most,” said board-certified dermatologist Suzanne M. Connolly, MD, FAAD, chair, Ad Hoc Task Force on the Development of Appropriate Use Criteria for Mohs Surgery. “The goal of the AUC is to provide evidence-based guidance on which types of skin cancer cases are most appropriate for this specialized surgery.”

Statistics and facts:

  • More than 3.5 million skin cancer cases affecting 2 million people are diagnosed annually.
  • Current estimates are that one in five Americans will be diagnosed with skin cancer in their lifetime.
About Mohs Surgery
Mohs surgery is a specialized skin cancer surgery in which a dermatologist who has completed additional training in Mohs surgery is able to remove skin cancer layer by layer until the entire tumor has been removed. The Mohs surgeon uses a microscope to examine each tissue layer to look for cancer cells until no further ones are found at any spot around any edges of the tumor. This technique allows the Mohs surgeon to preserve as much healthy tissue as possible, yet remove the entire cancer.  

Background
The AUC process was based on the well-established, credible method developed by the RAND Corporation/UCLA more than 30 years ago. AUC have been shown to improve patient selection, clinical outcomes and health-related quality of life while reducing overall cost and resource utilization. The Mohs AUC are the first AUC developed for any test or treatment option within the scope of dermatology.

Study details
  • The AUC process combines evidence-based medicine, clinical practice experience, and expert judgment.
  • Nearly 80 dermatologists, both Mohs surgeons and non-Mohs dermatologists, contributed to the development of this first AUC for the specialty, including a 17-member ratings panel that was balanced by expertise, society representation, type of practice, and geographic location.  
    • To manage potential conflict of interest, the majority of the Ratings Panel members were not Mohs surgeons.  
  • The collaboration of dermatologists involved in this process developed AUC for 270 scenarios for which Mohs surgery is frequently considered based on tumor and patient characteristics.
  • The Mohs AUC outline highly specific skin cancer patient scenarios that dermatologists encounter in daily clinical practice and classify the use of Mohs into one of three categories: appropriate, uncertain, or inappropriate.
  • At the conclusion of the rating process, consensus was reached for all 270 scenarios (100 percent) by the ratings panel, with 200 (74.07 percent) deemed as appropriate, 24 (8.89 percent) as uncertain and 46 (17.04 percent) as inappropriate.
    • With few exceptions, all scenarios involving the head, neck, hands, feet and genitalia are rated appropriate. An appropriate rating solely means that Mohs is an acceptable approach for that clinical scenario and patient; other approaches also may be considered based on physician assessment.
  • The benefits of these AUC are expected to be numerous and include:
    • Clinical decision support
    • Facilitation of discussions with referring physicians and patients
    • Support for research
    • Educational and quality improvement tools 
  • The Mohs AUC is a living document and intended to be modified as new clinical information is published or encountered in the practice setting. This new evidence may lead to future revisions to ratings as well as the clinical scenarios to more precisely define patient selection for Mohs surgery. 

“As the incidence of skin cancer continues to climb and the practice of Mohs surgery advances in the future, Mohs surgeons, dermatologists, primary care providers and the health care community in general will need to understand how to best utilize Mohs surgery in the treatment of skin cancer – and the AUC we initiated is an important first step in that direction,” said Dr. Connolly.

In 2011, the American Academy of Dermatology (Academy) established a collaborative and representative Ad Hoc Task Force (AHTF) on the Development of Appropriate Use Criteria for Mohs Surgery. The AHTF included members of the Academy, American College of Mohs Surgery, American Society for Mohs Surgery, and the American Society for Dermatologic Surgery Association. The process involved nearly 80 dermatologists, and placement of participants was balanced by the AHTF according to expertise, society representation, conflict of interest and many other factors. Numerous levels of process ensured the development of a final document of highest credibility and utility.

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