Mohs micrographic surgery vs traditional surgical excision: a cost comparison analysis.

OBJECTIVE

To compare the cost and margin adequacy of Mohs micrographic surgery (Mohs) and traditional surgical excision (TSE) for the treatment of facial and auricular nonmelanoma skin cancer (NMSC).

DESIGN

Prospective cost analysis with each patient serving as his or her own control.

SETTING

Study was performed from 1999 to 2001 at the University of Connecticut dermatology clinic, a tertiary care referral center.

PATIENTS

A total of 98 consecutive patients with a primary diagnosis of NMSC on the face and ears.

MAIN OUTCOME MEASURES

The average cost of Mohs and TSE per patient for the treatment and repair of NMSC; adequacy of TSE margins after the initial procedure(because this outcome affects overall cost).

RESULTS

Mohs was cost comparable to TSE when the subsequent procedure for inadequate TSE margins after permanent section was Mohs (937 vs 1029 US dollars; P =.16) or a subsequent TSE (937 vs 944 US dollars; P =.53). When facility-based frozen sections were requested for TSE, Mohs was significantly less costly (956 vs 1399 US dollars; P<.001). The cost difference between Mohs and TSE was sensitive to the type of repair chosen.

CONCLUSIONS

If the end point is clear margins, Mohs is cost comparable to TSE performed by otolaryngologic surgeons. Some caution is needed when evaluating the cost of facial and auricular NMSC treatment because the choice of repair can significantly affect the cost conclusions.