Don’t treat uncomplicated, keratinocyte carcinoma (BCC or SCC) less than 1 centimeter in size on the trunk and extremities with Mohs Micrographic Surgery, in otherwise healthy individuals.
In healthy individuals, the use of Mohs micrographic surgery for low-risk small (< 1cm), superficial or non-aggressive (based on appearance under a microscope) squamous cell carcinomas and basal cell carcinomas is inappropriate for skin cancers on the trunk and extremities. In these areas of the body, the clinical benefits of this specialized surgical procedure do not exceed the potential risks. It is important to note that Mohs micrographic surgery may be considered for skin cancers appearing on the hands, feet, ankles, shins, nipples or genitals, as they have been shown to have a higher risk for recurrence or require additional surgical considerations.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
The American Academy of Dermatology (AAD) is strongly committed to dermatologists serving as effective stewards of limited health care resources by assisting patients in making informed health care decisions. As such, the AAD leadership created a workgroup to develop this list with specific skills and expertise in evidence based research, public health quality and payer policy. Members of this workgroup include dermatologists who are current members of the Academy’s Board of Directors, Council on Science and Research, Council on Government Affairs, Health Policy and Practice, Research Agenda Committee, Clinical Guidelines Committee, Access to Dermatology Care Committee, Patient Safety and Quality Committee, Resource-Based Relative Value Scale Committee and the Workgroup on Innovative Payment Delivery. The workgroup identified areas to be included on this list based on the greatest potential for overuse/misuse, quality improvement and availability of strong evidence based research as defined by the recommended criteria listed below. The recommended list was reviewed and approved by the AAD Council on Science and Research and the AAD Board of Directors.
- Supported by available scientific evidence (e.g., existing AAD appropriate use criteria and/or existing AAD clinical guidelines)
- Strongest consensus inappropriate score from the AAD Appropriate Use Criteria (AUC)
- Strong (wording/level of evidence) recommendations from the guidelines about discouraged practice
- Greatest potential for improvement in outcomes for patients
- Greatest potential for overuse/misuse by physicians
AAD’s disclosure and conflict of interest policy can be found at www.aad.org.
Bichakjian C, Armstrong A, Baum C, Bordeaux JS, Brown M, Busam KJ, Eisen DB, Iyengar V, Lober C, Margolis DJ, Messina J. Guidelines of care for the management of basal cell carcinoma. J Am Acad of Dermatol. 2018;78(3):540-59.
Alam M, Armstrong A, Baum C, Bordeaux JS, Brown M, Busam KJ, Eisen DB, Iyengar V, Lober C, Margolis DJ, Messina J. Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol. 2018;78(3):560-78.
Connolly SM, Baker DR, Coldiron BM, Fazio MJ, Storrs PA, Vidimos AT, Zalla MJ, Brewer JD, Smith Begolka W; Ratings Panel, Berger TG, Bigby M, Bolognia JL, Brodland DG, Collins S, Cronin TA Jr, Dahl MV, Grant-Kels JM, Hanke CW, Hruza GJ, James WD, Lober CW, McBurney EI, Norton SA, Roenigk RK, Wheeland RG, Wisco OJ. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: a report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery. J Am Acad Dermatol. 2012 67(4):531–50.
NCCN Clinical Practice Guidelines in Oncology. Basal Cell Skin Cancer. Version 2. https://www.nccn.org/professionals/physician_gls/pdf/nmsc.pdf. Published 2021. Updated 2/25/2021. Accessed 3/5/2021.
NCCN Clinical Practice Guidelines in Oncology. Squamous Cell Skin Cancer. Version 1. https://www.nccn.org/professionals/physician_gls/pdf/squamous.pdf. Published 2021. Updated
2/5/2021. Accessed 3/5/202