Cost effectiveness of Mohs micrographic surgery.

Chren's study provides further evidence that for primary facial nonmelanoma skin cancers (NMSCs), recurrence rates with Mohs micrographic surgery (MMS) are modestly better than those for excision surgery. In 20 years, use of MMS has grown ∼10-fold and its cost now exceeds two billion dollars annually. Clinical experience and available data suggest that the skill of the treating physician is at least as important a determinant of outcome as the choice of MMS or excision. As patients and referring physicians increasingly share in the cost of more expensive procedures, evidence-based guidelines that establish the clinical circumstances in which the additional benefits of MMS outweigh its higher cost are needed, still lacking, and unlikely to become available.