MOHS MICROGRAPHIC SURGERY - A COST-ANALYSIS

Background: The incidence of skin cancer is increasing significantly, and many people have declared the increase an epidemic. It was estimat ed that 900,000 to 1.2 million cases of nonmelanoma skin cancer occurr ed in the United States in 1994. With increasing pressure to deliver c ost-effective medical care, physicians must understand the cost and va lue of the various methods to treat skin cancer. Objective: Our purpos e was to define the true cost of treating a series of skin cancers wit h the Mohs micrographic technique and compare our costs with calculate d estimates of the costs to treat the same cancers with traditional me thods of surgical excision. Methods: A group of 400 consecutive tumors was selected. The cost of treatment in the reference group included d iagnosis, Mohs micrographic surgery, reconstruction (if applicable), f ollow-up, and the cost to treat disease recurrence, These costs were t hen compared with traditional methods of surgical excision: excision w ith permanent section margin control, excision with frozen section mar gin control, and excision with frozen section margin control in an amb ulatory surgical facility. For cost comparisons, it was assumed that a ll tumors in the comparison groups would be excised with standard surg ical margins and the resultant surgical defects would be reconstructed with the simplest method possible. The costs of diagnosis, excision, pathology, reconstruction, and the cost to treat disease recurrence we re then calculated and compared with the costs of treating the lesions with Mohs micrographic surgery. Results: Our calculation of costs doc uments that Mohs micrographic surgery is similar in cost to office-bas ed traditional surgical excision and less expensive than ambulatory su rgical facility-based surgical excision. The average cost of Mohs micr ographic surgery was $1243 versus $1167 for excision with permanent se ction margin control, $1400 fur excision in the office with frozen sec tion margin control, and $1973 for excision with frozen section margin control in an ambulatory surgical facility. Analysis based on anatomi c location yielded similar results. Conclusion: Mohs micrographic surg ery is a method of surgical excision with high intrinsic value that is cost-effective in comparison to traditional surgical excision.