Mohs Appropriate Use Criteria for Superficial Basal Cell Carcinoma

Abstract

used in Gerami et al, 2 which was selected to understand the true NPV (above 99%) in the clinical setting and not simply in a research validation setting. Again, by way of comparison with the current histopathologic pathway using a 7% prevalence, the calculated NPV from Elmore et al 5 for early-stage melanoma based on the sensitivity described herein is well below 83%. 1,4,5 It is also important to note that 708 PLAevaluated real-world lesions have now been followed up for over a year, and no missed melanomas have been identified (D.M.S. and Laura K. Ferris, MD, PhD, unpublished observations), further supporting the high NPV of the PLA.We agree that it is important to carefully test new technologies such as the PLA. To date, the performance of the PLA has been established and corroborated by over 40 investigators, and findings have been summarized in over 10 peerreviewed publications including the references found in Gerami et al, 2 Ferris et al, 3 Hornberger and Siegel, 1 and Rivers et al. 4 Additional corroborating data sets come from over 1350 clinicians in 40 US states who have used the PLA on over 20 000 patients. If used as intended, the PLA improves the current diagnostic paradigm of ruling out melanoma by reducing the number needed to biopsy about 10-fold from about 25 6 to 2.7, 4 while significantly increasing the NPV to 99%. This in turn drives cost savings for the health care system (−47% at the PLA selling price reference point of $500) and demonstrates that the PLA is a new technology that can deliver better care at a lower cost. [1][2][3][4]