Mohs micrographic surgery and surgical excision for nonmelanoma skin cancer treatment in the medicare population

Objectives: To identify Medicare use rates of Mohs micrographic surgery (MMS) and surgical excision for the treatment of nonmelanoma skin cancer (NMSC) and to identify patient, lesion, and geographic characteristics associated with treatment type. Design:Aretrospective analysis of Medicare beneficiaries. Setting: Surveillance, Epidemiology, and End Results database. Patients: Patients undergoingMMSor other surgical intervention for the treatment of NMSC from January 1, 2001, through December 31, 2006. Main Outcome Measures: Surgical treatment, patient, and lesion characteristics. Results: A total of 26 931 operations were performed for the treatment ofNMSCfrom 2001 through 2006, of which 36.4% were MMS. Although the rate of surgical excision slightly increased during this period (1.8 vs 2.1 per 100 Medicare beneficiaries), the rate of MMS doubled (0.75 vs 1.5 per 100 Medicare beneficiaries). In 46.9% of facial lesions, MMS was performed, whereas MMS was used to treat 14.7% of total body lesions. Atlanta, Georgia, had the highest proportion of patients treated with MMS (45.1%); Louisiana had the lowest (11.0%). Age, race, lesion location, and area of country for patient treatment were significantly associated with MMS use (all P<.001). Conclusions: Surgical treatment ofNMSCincreased substantially from 2001 through 2006, primarily because of a doubling in the rate ofMMSprocedures. Significant differences in surgical rates, depending on patient age, race, lesion location, and geographic region, of treatment were found.