Preoperative Expectations and Values of Patients Undergoing Mohs Micrographic Surgery

Chuang, Gary S.; Leach, Brian C.; Wheless, Lee; Lang, P.G.; Cook, Joel

doi:10.1111/j.1524-4725.2011.01878.x

Cited by 13 publications

(8 citation statements)

References 53 publications

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“…Our data suggest that these patients may have benefited from simpler reconstruction procedures of their primary melanomas. Patients place high value on restoring a normal appearance after reconstruction of facial defects,(13–15) so optimizing outcomes by confirming clear margins prior to reconstruction is especially important for melanomas in cosmetically or functionally sensitive locations. The incidence of flap or graft reconstruction did not vary between melanoma in situ (48.0%) and invasive melanoma (47.5%) [p = 0.9230].…”

Section: Discussionmentioning

confidence: 99%

Correlation Between Appropriate Use Criteria and the Frequency of Subclinical Spread or Reconstruction With a Flap or Graft for Melanomas Treated With Mohs Surgery With Melanoma Antigen Recognized by T Cells 1 Immunostaining

Etzkorn

Sobanko

Shin

et al. 2016

Dermatologic Surgery

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Background Published appropriate use criteria (AUC) for Mohs micrographic surgery (MMS) for melanoma are based on consensus opinion. Objective To evaluate whether published AUC identify melanomas for which MMS may benefit patients by detecting subclinical spread or confirming clear microscopic margins prior to flap or graft reconstruction. Materials and methods Retrospective cohort study of 591 melanomas in 556 patients evaluating the correlation between current AUC (anatomic location, recurrent status, and tumor stage) and subclinical spread or reconstruction with a flap or graft. Results Anatomic location on the head, neck, genitalia, hands, feet, or pretibial leg was significantly associated with a higher frequency of subclinical spread (OR 1.89, p=0.0280) and flap or graft reconstruction (OR 10.3, p=0.0001). Compared to primary lesions, recurrent melanomas had a higher frequency of subclinical spread (OR 1.78, p=0.0104) and reconstruction with a flap or graft (OR 1.67, p=0.0217). The frequencies of subclinical spread and flap or graft reconstruction did not differ between in situ and invasive melanomas. Conclusion Anatomic location and recurrent status are useful criteria to identify melanomas that may benefit from MMS. Tumor stage is not a useful criterion, as MMS has similar benefits for subsets of both invasive and in situ melanomas.

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Section: Discussionmentioning

confidence: 99%

Correlation Between Appropriate Use Criteria and the Frequency of Subclinical Spread or Reconstruction With a Flap or Graft for Melanomas Treated With Mohs Surgery With Melanoma Antigen Recognized by T Cells 1 Immunostaining

Etzkorn

Sobanko

Shin

et al. 2016

Dermatologic Surgery

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“…Fourteen patients required a second interpolated flap during the time period surveyed; all of these patients elected to have the procedure performed under local anesthesia. Prior work by our group has shown that patients undergoing MMS highly value the fact that the surgery is done on an outpatient basis and that it does not require general anesthesia . There has been an overall trend toward awake, nonsedated, in‐office technique for procedures typically performed under general anesthesia, such as laryngeal, tracheal, and esophageal procedures; prostate biopsies; craniotomies; and inguinal hernia repair .…”

Section: Discussionmentioning

confidence: 99%

Safety of Staged Interpolation Flaps After Mohs Micrographic Surgery in an Outpatient Setting: A Single-Center Experience

Newlove

Cook

2013

Dermatologic Surgery

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“…Patients have been found to have higher expectations if the treating physician is a skin cancer specialist. 41 Also, a survey among 467 patients indicates that plastic surgeons may be viewed by the public as more surgically skillful than dermatology surgeons despite no patient-reported differences in the assessment of the cosmetic appearance of the surgical scars. 42 Unfortunately, patient preferences are not observable in the MCBS claims data set to control for any potentially existing specialty selection or referral bias.…”

Section: Discussionmentioning

confidence: 99%

Physician Specialty Cost Differences of Treating Nonmelanoma Skin Cancer

Chirikov¹,

Stuart²,

Zuckerman³

et al. 2015

Annals of Plastic Surgery

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Specialty-related cost differences for the treatment of nonmelanoma skin cancer (NMSC) have been previously reported but without taking into account confounding factors. Using a previously validated model for NMSC episode of care, episodes were identified in the Medicare Current Beneficiary Survey claims 2005 to 2007. A γ regression with log link model estimated the effect of physician exposure on total episode costs controlling for sociodemographics, health status and comorbidities, treatment and repair procedures, as well as tumor size and location. Treatment-related NMSC episodes (1285) were identified. In the unadjusted model, episodes managed by generalists were associated with 36% lower costs, those by otolaryngologists/plastic surgeons with 82% higher costs, and those by multiple specialists with 111% higher costs, compared to dermatologists. Cost differences were substantially reduced in the adjusted regression analysis; compared to dermatologists, episodes managed by generalists were associated with 20% lower costs (P < 0.0001), whereas otolaryngologists/plastic surgeons and multiple specialists were associated with 20% (P < 0.01) and 11% (P = 0.02) higher costs, respectively. Overall, comparison between unadjusted and adjusted estimates suggests that controlling for severity and treatment modalities explains most of the specialty cost differences. Our estimates could be subject to residual confounding due to selection bias and the limitations to using claims data to characterize an NMSC episode of care. Adjusting for the severity of the disease and other confounders, our study found much smaller specialty-related cost differences for the management of NMSC than previously reported unadjusted estimates.

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Preoperative Expectations and Values of Patients Undergoing Mohs Micrographic Surgery

Abstract: Our data corroborate that MMS is a valuable procedure that meets the expectations not just of physicians, but also of patients. The authors have indicated no significant interest with commercial supporters.

Cited by 13 publications

References 53 publications

Correlation Between Appropriate Use Criteria and the Frequency of Subclinical Spread or Reconstruction With a Flap or Graft for Melanomas Treated With Mohs Surgery With Melanoma Antigen Recognized by T Cells 1 Immunostaining

Correlation Between Appropriate Use Criteria and the Frequency of Subclinical Spread or Reconstruction With a Flap or Graft for Melanomas Treated With Mohs Surgery With Melanoma Antigen Recognized by T Cells 1 Immunostaining

Safety of Staged Interpolation Flaps After Mohs Micrographic Surgery in an Outpatient Setting: A Single-Center Experience

Physician Specialty Cost Differences of Treating Nonmelanoma Skin Cancer

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