ABSTRACT
Objective: The purpose of the present work was to develop evidence-based indications for Mohs micrographic surgery in patients with a diagnosis of skin cancer. Methods: The guideline was developed by Cancer Care Ontario's Program in Evidence-Based Care, together with the Melanoma Disease Site Group and the Surgical Oncology Program, through a systematic review of relevant literature, patient- and caregiver-specific consultation, and internal and external reviews. Recommendation 1: Given a lack of high-quality, comparative evidence, surgery (with postoperative or intraoperative margin assessment) or radiation (for those who are ineligible for surgery) should remain the standard of care for patients with skin cancer. Recommendation 2: Mohs micrographic surgery is recommended for patients with histologically confirmed recurrent basal cell carcinoma of the face and is appropriate for primary basal cell carcinomas of the face that are larger than 1 cm, have aggressive histology, or are located on the H zone of the face. Recommendation 3: Mohs micrographic surgery should be performed by physicians who have completed a degree in medicine or equivalent, including a Royal College of Physicians and Surgeons of Canada Specialist Certificate or equivalent, and have received advanced training in Mohs micrographic surgery.
Subject(s)
Mohs Surgery/methods , Guidelines as Topic , Humans , Treatment OutcomeABSTRACT
BACKGROUND: Mohs micrographic surgery (MMS) is used for the removal of difficult or recurrent skin cancer. Little is known about the behavioral changes of patients who have undergone this procedure. OBJECTIVE: This study was conducted to document patients' long-term psychological and behavioral changes following MMS. METHODS: A survey was mailed to a sample of 260 persons who underwent the Mohs procedure in 1997. It included questions on sunscreen use, level of anxiety about cancer, patient confidence in MMS, and changes in high-risk habits. RESULTS: The study included 214 patients who responded to our mailed questionnaire. Trends showed an increase in some but not all preventative measures taken to avoid skin cancer recurrence post-MMS. Other healthy lifestyle changes, such as decreased cigarette smoking, were not noted. CONCLUSION: Mohs micrographic surgery has an impact on some aspects of patients' health-related behavior, especially skin cancer prevention. Other aspects which are not affected may be targets for extra patient education.