A good understanding and appreciation of Mohs AUC by surgeons who utilize micrographic dermatology surgery (Mohs) is incredibly useful. An application is available for Apple and Android users for Mohs AUC, and can be found
here. This application can be very helpful to make sure each individual tumor is appropriate for Mohs surgery.
Micrographic dermatologic surgery is the gold standard for treatment of skin cancer. Its use needs to be appropriate. The American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and American Society for Mohs Surgery collaborated to publish appropriate use criteria for Mohs micrographic surgery (MMS) (
Connolly et al. JAAD 2012). They make a recommendation on appropriate use criteria MMS in 270 clinical situations. A consensus was reached for all 270 clinical situations, with 200 (74.1%) deemed appropriate, 24 (8.9%) deemed uncertain, and 46 (17.0%) deemed inappropriate. Of note, the recommendations put forward for Mohs appropriate use criteria are supported by the
NCCN Guidelines.
Appropriate Use Criteria for micrographic dermatologic surgery (Mohs):
Mask areas of the face (central face, eyelids, eyebrows, nose, lips, chin, ears, periauricular, temple, genitalia, perineal, perianal, hands, feet, nails, ankles, nipples)
Appropriate (score of 7-9)
- BCC
- Primary or Recurrent: Aggressive, Nodular, or Superficial
- SCC
- Primary or Recurrent: Aggressive, Nonaggressive, Verrucous, KA-type not central facial, SCC-in situ/Bowen's
- LM and MIS
- Primary or Recurrent: LM, MIS
Inappropriate
- SCC
- Primary or Recurrent: AK with focal SCC in situ
Cheeks, forehead, scalp, neck, jawline, pretibial surface
Appropriate
- BCC
- Primary or Recurrent: Aggressive, Nodular, Superficial in immunocompromised
- Primary: Superficial ≥ 0.6cm
- SCC
- Primary or Recurrent: Aggressive, Nonaggressive, KA-type not central facial, SCC in situ/Bowen's
- LM and MIS
- Primary or recurrent: LM; MIS
Uncertain- BCC
- Primary: Superficial ≤ 0.5cm
Inappropriate
- SCC
- Primary or recurrent: AK with focal SCC in situ
Trunk and extremities (excludes pretibial, hands, feet, nails, ankles)
Appropriate
- BCC
- Recurrent: Aggressive, Nodular
- Primary: Aggressive ≥ 0.6cm, Nodular ≥ 2.0cm, Nodular in immunocompromised ≥ 1.1cm
- SCC
- Primary or recurrent: Aggressive
- Recurrent: KA-type, Nonaggressive
- Primary ≥ 2.0cm: Nonaggressive, SCC in situ/Bowen's
- Primary ≥ 1.1cm: Nonaggressive in immunocompromised, KA-type, SCC in situ/Bowen's in immunocompromised
- KA-type SCC in immunocompromised ≥ 0.6cm
Uncertain
- BCC
- Primary: Aggressive ≤ 0.5cm, Nodular 1.1-2.0cm, Nodular in immunocompromised 0.6-1.0cm, Superficial in immunocompromised ≥ 1.1cm
- SCC
- Recurrent: SCC in situ/Bowen's
- Primary 1.1-2.0cm: Nonaggressive, SCC in situ/Bowen's
- Primary ≤ 1.0cm: Nonaggressive in immunocompromised
- Primary 0.6-1.0cm: SCC in situ/Bowen's in immunocompromised
- Primary ≤ 0.5cm: KA-type in immunocompromised
Inappropriate
- BCC
- Recurrent: superficial
- Primary: Nodular ≤ 1.0cm, Nodular in immunocompromised ≤ 0.5cm, Superficial, Superficial in immunocompromised ≤ 1.0cm
- SCC
- Primary or recurrent: AK with focal SCC in situ
- Primary ≤ 1.0cm: Nonaggressive, KA, SCC in situ/Bowen's
- Primary ≤ 0.5cm: SCC in situ/Bowen's in immunocompromised
Clinical Pearl: National Societies, including the American Academy of Dermatology, American Society of Dermatologic Surgery, American College of Mohs Surgery, and NCCN Guidelines, have published data that guide appropriate selection of cutaneous malignancies for treatment with micrographic dermatologic surgery (Mohs). Immunosuppression status plays a big role in Mohs AUC for determination of appropriateness of Mohs surgery for treatment of squamous cell carcinoma.