Mohs Surgery for SEER Registry-Captured Melanoma In Situ and Rare Cutaneous Tumors: Comparing National Utilization Patterns Before and After Implementation of the Affordable Care Act (2010) and Appropriate Use Criteria (2012).

Publication date: Jan 09, 2020

The Affordable Care Act (ACA) and the appropriate use criteria (AUC) for Mohs micrographic surgery (MMS) had the potential to increase utilization rates of MMS for indicated skin cancers, but it is unknown whether this has occurred.

To determine whether rates of MMS utilization for head and neck melanoma in situ (MIS) and rare cutaneous tumors (RCTs) increased after the implementation of the ACA and AUC publication.

Retrospective review using data from the SEER database. Melanoma in situ and RCT tumor cases from before and after the ACA and AUC publication were compared.

Twenty-four thousand six hundred seventy-eight cases were analyzed. Mohs micrographic surgery utilization for MIS decreased from 13.9% before the ACA to 12.3% after the ACA (odds ratio 0.87; p = .012). There was no significant change in MMS utilization for MIS after publication of the AUC. There was also no significant change in MMS utilization for treatment of RCT after the ACA or AUC publication. Stratification of patients into age groups younger or older than 65 years did not change utilization rates.

Rates of MMS for treatment of MIS and RCT have not increased since the advent of the ACA or AUC. This finding highlights the need for continued efforts to improve access to MMS and to increase education of its utility in treating skin cancer.

Garland, K., Condon, S., Xiong, D.D., Crowe, D., and Knackstedt, T.J. Mohs Surgery for SEER Registry-Captured Melanoma In Situ and Rare Cutaneous Tumors: Comparing National Utilization Patterns Before and After Implementation of the Affordable Care Act (2010) and Appropriate Use Criteria (2012). 25439. 2020 Dermatol Surg.

Concepts Keywords
AUC Tumor
Melanoma Tumors
MIS Melanoma
MMS Skin cancer
Mohs Micrographic Surgery Surgery
Mohs Surgery RTT
Odds Ratio Medicine
Skin Cancer Clinical medicine
Tumor Medical specialties
Melanoma
Skin cancer
Mohs surgery
Dermatology

Semantics

Type Source Name
disease MESH Melanoma
pathway KEGG Melanoma
disease MESH Tumors
drug DRUGBANK Trihexyphenidyl
disease MESH skin cancers

Original Article

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