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Mohs Micrographic Surgery in Medicare Population


Tim Casey

New Orleans—Between 2001 and 2006 the number of patients in the Medicare population receiving Mohs micrographic surgery (MMS) for nonmelanoma skin cancer (NMSC) doubled, according to a retrospective review of Medicare patients receiving surgical intervention for NMSC. However, during the same time period, the rate of patients undergoing surgeries remained stable. The results, based on the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program, were revealed during an oral abstract session and poster presentation titled The Use of Mohs Micrographic Surgery for the Treatment of Nonmelanoma Skin Cancer in the Medicare Population. Kate V. Viola, MD, Albert Einstein College of Medicine in Bronx, New York, was the study’s lead author. The authors said this was the first study to examine the use of MMS for NMSC in Medicare patients. MMS, intended for patients with skin cancer, is associated with low recurrence rates, optimal preservation of normal tissue, favorable cosmetic outcomes, and increased patient satisfaction, according to the authors. Although the AAD has guidelines for using MMS in skin cancer patients, the authors indicated that there have been few analyses of how physicians treat Medicare patients with NMSC undergoing surgical resection. The authors examined a 5% sample of Medicare claims from the SEER database and summarized their findings by age, sex, race, tumor anatomy, margin size, and geographic region. The 16 SEER cancer registries account for 26% of the US population, according to the authors. They wanted to examine trends of MMS and other surgical interventions for NMSC in the Medicare population; identify patient, lesion, and geographic determinants associated with the type of surgical intervention; and identify surgeon density and MMS use by SEER region. The analysis established that 26,931 Medicare patients underwent surgery for NMSC between 2001 and 2006, including 9802 (36%) who received MMS and 17,129 who had another procedure. The authors said the number of NMSC procedures increased between 12% and 20% each year during that time period. A bivariate analysis found that age, race, region of the country, and lesion location were associated with MMS for skin cancer treatment (P<.001 for each variable). In the MMS group, 57.2% of patients were male and 99.0% were white, and 83.8% of MMS was completed on the head or neck. The breakdown for patients undergoing MMS was 7.6% between 67 and 69 years of age, 20.7% between 70 and 74 years of age, 29.5% between 75 and 79 years of age, 24.6% between 80 and 84 years, and 17.6% ≥85 years of age. In addition, 52% of MMS was performed in the western United States. MMS utilization was highest in California, particularly in Los Angeles (42% of patients undergoing surgery for NMSC received MMS), San Francisco/Oakland (28% of patients undergoing surgery for NMSC received MMS), and San Jose/Monterey (36% of patients undergoing surgery for NMSC received MMS). Atlanta and Detroit also had a high rate of patients undergoing MMS, 45% and 41%, respectively. The authors cited possible selection bias as a limitation to the study because the patients were ≥65 years of age and lived in regions of the country in which there were SEER registries. Patients living in New York (where there are many surgeons who perform MMS) and Florida (where there is a higher risk of NMSC) were excluded because there are no SEER registries in those states.

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