Ross Levy

Association Between Number of Stages in Mohs Micrographic Surgery and Surgeon-, Patient-, and Tumor-Specific Features: A Cross-Sectional Study of Practice Patterns of 20 Early- and Mid-Career Mohs Surgeons

OBJECTIVE To determine the number of Mohs micrographic surgery (MMS) stages per tumor taken by early‐ to mid‐career Mohs surgeons and to assess other factors affecting number of stages. METHODS Statistical analysis of MMS logs of 20 representative early‐ to mid‐career surgeons. RESULTS There was no difference in stages when surgeons were divided into two categories based on whether they had more than 500 cases per year or more than 5 years of experience. Similarly, when surgeons were categorized according to geographic location, there was no difference in number of stages. Anatomic location was associated with the number of stages (analysis of variance, p<.001), with the greatest number of stages for nose (2.01) and ear (2.06) lesions and the fewest for neck (1.47), back and shoulder (1.47), and lower extremity (1.33) lesions. Basal cell carcinomas required 1.92 stages (median 2.00), compared with 1.66 (median 1.00) for squamous cell carcinoma (p<.001). CONCLUSIONS Early‐ and mid‐career Mohs surgeons appear to remove tumors with similar numbers of stages regardless of their experience, case volume, or geographic location. Number of stages varies with anatomic location and tumor type. &NA; The authors have indicated no significant interest with commercial supporters.

Mohs micrographic surgery: Facts and controversies

The field of Mohs micrographic surgery has expanded in the last 70 years, as have the indications for the procedure and the techniques that have been used. As a result, differences in the practice of Mohs micrographic surgery have emerged. This contribution explores current controversies within Mohs micrographic surgery and critically appraises the available evidence on both sides of the issues.

Association Between Type of Reconstruction After Mohs Micrographic Surgery and Surgeon-, Patient-, and Tumor-Specific Features: A Cross-Sectional Study

BACKGROUND There are few data to indicate whether the type of final wound defect is associated with the type of post‐Mohs repair. OBJECTIVE To determine the methods of reconstruction that Mohs surgeons typically select and, secondarily, to assess the association between the method and the number of stages, tumor type, anatomic location, and patient and surgeon characteristics. METHODS Statistical analysis of procedure logs of 20 representative young to mid‐career Mohs surgeons. RESULTS The number of stages associated with various repairs were different (analysis of variance, p < .001.). Linear repairs, associated with the fewest stages (1.5), were used most commonly (43–55% of defects). Primary repairs were used for 20.2% to 35.3% of defects of the nose, eyelids, ears, and lips. Local flaps were performed typically after two stages of Mohs surgery (range 1.98–2.06). Referral for repair and skin grafts were associated with cases with more stages (2.16 and 2.17 stages, respectively). Experienced surgeons were nominally more likely perform flaps than grafts. Regression analyses did not indicate any association between patient sex and closure type (p = .99) or practice location and closure type (p = .99). CONCLUSIONS Most post‐Mohs closures are linear repairs, with more bilayered linear repairs more likely at certain anatomic sites and after a larger number of stages.

Characteristics of dermatologists who read dermatopathology slides.

Background:  The characteristics and prevalence of dermatologists reading dermatopathology slides are not well understood.