Surgical procedures for skin cancer via medicare examined

According to an evaluation of Medicare beneficiaries, there has been a significant increase in surgical treatment for nonmelanoma skin cancer (NMSC), from 2001 until 2006. The study, published in the April issue of Archives of Dermatology, states that the increase is primarily due to a doubling in the rate of Mohs micrographic surgery procedures. According to background information in the study, each year, over 3 million NMSCs are diagnosed in the U.S. Treatment options vary from surgical excision to Mohs micrographic surgery (MMS), which involves examining 100% of the surgical margin during the procedure. Whilst most primary basal cell carcinomas surgical excision proves effective, cure rates are higher with MMS in patients with recurrent, infiltrative and high-risk anatomical site cancers. For instance, on the face. The researchers point out that there is a debate as to which option, i.e. MMS or surgical excision, is more effective for primary NMSC, as well as MMSs cost-efficacy. Kate V. Viola, M.D., M.H.S., of the Albert Einstein College of Medicine in New York, and her team performed a retrospective evaluation of a 5% sample of Medicare beneficiaries that consisted of a total of 26,931 patients, of which 9,802 patients or 36.4% had MMS and 17,129 patients or 63.6% had surgical excisions to treat NMSC, between 2001 until 2006. They noted that the rate of MMS doubled from 0.75 to 1.5, per 100 Medicare beneficiaries, during the study period, whilst the rate for surgical excisions only rose marginally from 1.8 to 2.1 per 100 Medicare beneficiaries. They noted that patients had a 60.1% higher chance of receiving MMS if their lesions were on the lip, and 57.2% if it was on the eyelid, compared with 39.9% of surgical excisions on the lip, and 42.8% on the eyelid. The researchers note that the highest percentage of NMSC patients who were treated with MMS was in Atlanta (45.1%), and that the majority of patients who received MMS were younger patients. They conclude: "To our knowledge, this is the only study to examine the national patterns of use of MMS for NMSC over time. Patient age and lesion location were significantly associated with the type of surgery (MMS vs. surgical excision), yet there were wide variations in regional MMS use and geographical disparity that warrant further investigation. Additional large, prospective studies are needed to further identify surgical treatment outcomes for NMSC."