496 lines
No EOL
74 KiB
HTML
496 lines
No EOL
74 KiB
HTML
<?xml version="1.0" encoding="utf-8"?>
|
||
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
|
||
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en">
|
||
|
||
<head><meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
|
||
<!-- AppResources meta begin -->
|
||
<meta name="paf-app-resources" content="" />
|
||
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
||
|
||
<!-- AppResources meta end -->
|
||
|
||
<!-- TemplateResources meta begin -->
|
||
<meta name="paf_template" content="" />
|
||
|
||
<!-- TemplateResources meta end -->
|
||
|
||
<!-- Logger begin -->
|
||
<meta name="ncbi_db" content="books" /><meta name="ncbi_pdid" content="book-part" /><meta name="ncbi_acc" content="NBK603719" /><meta name="ncbi_domain" content="statpearls" /><meta name="ncbi_report" content="record" /><meta name="ncbi_type" content="fulltext" /><meta name="ncbi_objectid" content="" /><meta name="ncbi_pcid" content="/NBK603719/" /><meta name="ncbi_pagename" content="Mohs Micrographic Surgery Appropriate Use Criteria (AUC) Guidelines - StatPearls - NCBI Bookshelf" /><meta name="ncbi_bookparttype" content="chapter" /><meta name="ncbi_app" content="bookshelf" />
|
||
<!-- Logger end -->
|
||
|
||
<title>Mohs Micrographic Surgery Appropriate Use Criteria (AUC) Guidelines - StatPearls - NCBI Bookshelf</title>
|
||
|
||
<!-- AppResources external_resources begin -->
|
||
<link rel="stylesheet" href="/core/jig/1.15.2/css/jig.min.css" /><script type="text/javascript" src="/core/jig/1.15.2/js/jig.min.js"></script>
|
||
|
||
<!-- AppResources external_resources end -->
|
||
|
||
<!-- Page meta begin -->
|
||
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="StatPearls [Internet]" /><meta name="citation_title" content="Mohs Micrographic Surgery Appropriate Use Criteria (AUC) Guidelines" /><meta name="citation_publisher" content="StatPearls Publishing" /><meta name="citation_date" content="2024/05/05" /><meta name="citation_author" content="Fahad S. Siddiqui" /><meta name="citation_author" content="Adam Leavitt" /><meta name="citation_pmid" content="38753911" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK603719/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Mohs Micrographic Surgery Appropriate Use Criteria (AUC) Guidelines" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="StatPearls Publishing" /><meta name="DC.Contributor" content="Fahad S. Siddiqui" /><meta name="DC.Contributor" content="Adam Leavitt" /><meta name="DC.Date" content="2024/05/05" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK603719/" /><meta name="description" content="Mohs micrographic surgery (MMS), named after Dr. Frederic Mohs, is a specialized tissue-sparing surgical technique for treating certain types of skin cancer. This procedure is renowned for its effectiveness in completely removing cancerous tissue while preserving as much healthy skin as possible. The surgeon performing this procedure can take little to no margin when removing cancer due to tissue mapping and full-margin analysis with a frozen section. Mohs surgery is particularly advantageous for skin cancers with indistinct clinical borders or those in critical areas, such as the face, where tissue preservation is crucial for cosmetic and functional reasons.[1]" /><meta name="og:title" content="Mohs Micrographic Surgery Appropriate Use Criteria (AUC) Guidelines" /><meta name="og:type" content="book" /><meta name="og:description" content="Mohs micrographic surgery (MMS), named after Dr. Frederic Mohs, is a specialized tissue-sparing surgical technique for treating certain types of skin cancer. This procedure is renowned for its effectiveness in completely removing cancerous tissue while preserving as much healthy skin as possible. The surgeon performing this procedure can take little to no margin when removing cancer due to tissue mapping and full-margin analysis with a frozen section. Mohs surgery is particularly advantageous for skin cancers with indistinct clinical borders or those in critical areas, such as the face, where tissue preservation is crucial for cosmetic and functional reasons.[1]" /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK603719/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-statpearls-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/statpearls/article-149624/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK603719/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" media="print" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript" src="/corehtml/pmc/js/large-obj-scrollbars.min.js"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script><meta name="book-collection" content="NONE" />
|
||
|
||
<!-- Page meta end -->
|
||
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico" /><meta name="ncbi_phid" content="CE8E9CC47C8030610000000000A30078.m_13" />
|
||
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3985586/3808861/4121862/3974050/3917732/251717/4216701/14534/45193/4113719/3849091/3984811/3751656/4033350/3840896/3577051/3852958/4008682/4207974/4206132/4062871/12930/3964959/3854974/36029/4128070/9685/3549676/3609192/3609193/3609213/3395586.css" /><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3411343/3882866.css" media="print" /></head>
|
||
<body class="book-part">
|
||
<div class="grid">
|
||
<div class="col twelve_col nomargin shadow">
|
||
<!-- System messages like service outage or JS required; this is handled by the TemplateResources portlet -->
|
||
<div class="sysmessages">
|
||
<noscript>
|
||
<p class="nojs">
|
||
<strong>Warning:</strong>
|
||
The NCBI web site requires JavaScript to function.
|
||
<a href="/guide/browsers/#enablejs" title="Learn how to enable JavaScript" target="_blank">more...</a>
|
||
</p>
|
||
</noscript>
|
||
</div>
|
||
<!--/.sysmessage-->
|
||
<div class="wrap">
|
||
<div class="page">
|
||
<div class="top">
|
||
<div id="universal_header">
|
||
<section class="usa-banner">
|
||
<div class="usa-accordion">
|
||
<header class="usa-banner-header">
|
||
<div class="usa-grid usa-banner-inner">
|
||
<img src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/favicons/favicon-57.png" alt="U.S. flag" />
|
||
<p>An official website of the United States government</p>
|
||
<button class="non-usa-accordion-button usa-banner-button" aria-expanded="false" aria-controls="gov-banner-top" type="button">
|
||
<span class="usa-banner-button-text">Here's how you know</span>
|
||
</button>
|
||
</div>
|
||
</header>
|
||
<div class="usa-banner-content usa-grid usa-accordion-content" id="gov-banner-top" aria-hidden="true">
|
||
<div class="usa-banner-guidance-gov usa-width-one-half">
|
||
<img class="usa-banner-icon usa-media_block-img" src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-dot-gov.svg" alt="Dot gov" />
|
||
<div class="usa-media_block-body">
|
||
<p>
|
||
<strong>The .gov means it's official.</strong>
|
||
<br />
|
||
Federal government websites often end in .gov or .mil. Before
|
||
sharing sensitive information, make sure you're on a federal
|
||
government site.
|
||
</p>
|
||
</div>
|
||
</div>
|
||
<div class="usa-banner-guidance-ssl usa-width-one-half">
|
||
<img class="usa-banner-icon usa-media_block-img" src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-https.svg" alt="Https" />
|
||
<div class="usa-media_block-body">
|
||
<p>
|
||
<strong>The site is secure.</strong>
|
||
<br />
|
||
The <strong>https://</strong> ensures that you are connecting to the
|
||
official website and that any information you provide is encrypted
|
||
and transmitted securely.
|
||
</p>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</section>
|
||
<div class="usa-overlay"></div>
|
||
<header class="ncbi-header" role="banner" data-section="Header">
|
||
|
||
<div class="usa-grid">
|
||
<div class="usa-width-one-whole">
|
||
|
||
<div class="ncbi-header__logo">
|
||
<a href="/" class="logo" aria-label="NCBI Logo" data-ga-action="click_image" data-ga-label="NIH NLM Logo">
|
||
<img src="https://www.ncbi.nlm.nih.gov/coreutils/nwds/img/logos/AgencyLogo.svg" alt="NIH NLM Logo" />
|
||
</a>
|
||
</div>
|
||
|
||
<div class="ncbi-header__account">
|
||
<a id="account_login" href="https://account.ncbi.nlm.nih.gov" class="usa-button header-button" style="display:none" data-ga-action="open_menu" data-ga-label="account_menu">Log in</a>
|
||
<button id="account_info" class="header-button" style="display:none" aria-controls="account_popup" type="button">
|
||
<span class="fa fa-user" aria-hidden="true">
|
||
<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24" width="20px" height="20px">
|
||
<g style="fill: #fff">
|
||
<ellipse cx="12" cy="8" rx="5" ry="6"></ellipse>
|
||
<path d="M21.8,19.1c-0.9-1.8-2.6-3.3-4.8-4.2c-0.6-0.2-1.3-0.2-1.8,0.1c-1,0.6-2,0.9-3.2,0.9s-2.2-0.3-3.2-0.9 C8.3,14.8,7.6,14.7,7,15c-2.2,0.9-3.9,2.4-4.8,4.2C1.5,20.5,2.6,22,4.1,22h15.8C21.4,22,22.5,20.5,21.8,19.1z"></path>
|
||
</g>
|
||
</svg>
|
||
</span>
|
||
<span class="username desktop-only" aria-hidden="true" id="uname_short"></span>
|
||
<span class="sr-only">Show account info</span>
|
||
</button>
|
||
</div>
|
||
|
||
<div class="ncbi-popup-anchor">
|
||
<div class="ncbi-popup account-popup" id="account_popup" aria-hidden="true">
|
||
<div class="ncbi-popup-head">
|
||
<button class="ncbi-close-button" data-ga-action="close_menu" data-ga-label="account_menu" type="button">
|
||
<span class="fa fa-times">
|
||
<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 48 48" width="24px" height="24px">
|
||
<path d="M38 12.83l-2.83-2.83-11.17 11.17-11.17-11.17-2.83 2.83 11.17 11.17-11.17 11.17 2.83 2.83 11.17-11.17 11.17 11.17 2.83-2.83-11.17-11.17z"></path>
|
||
</svg>
|
||
</span>
|
||
<span class="usa-sr-only">Close</span></button>
|
||
<h4>Account</h4>
|
||
</div>
|
||
<div class="account-user-info">
|
||
Logged in as:<br />
|
||
<b><span class="username" id="uname_long">username</span></b>
|
||
</div>
|
||
<div class="account-links">
|
||
<ul class="usa-unstyled-list">
|
||
<li><a id="account_myncbi" href="/myncbi/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_myncbi">Dashboard</a></li>
|
||
<li><a id="account_pubs" href="/myncbi/collections/bibliography/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_pubs">Publications</a></li>
|
||
<li><a id="account_settings" href="/account/settings/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_settings">Account settings</a></li>
|
||
<li><a id="account_logout" href="/account/signout/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_logout">Log out</a></li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
|
||
</div>
|
||
</div>
|
||
</header>
|
||
<div role="navigation" aria-label="access keys">
|
||
<a id="nws_header_accesskey_0" href="https://www.ncbi.nlm.nih.gov/guide/browsers/#ncbi_accesskeys" class="usa-sr-only" accesskey="0" tabindex="-1">Access keys</a>
|
||
<a id="nws_header_accesskey_1" href="https://www.ncbi.nlm.nih.gov" class="usa-sr-only" accesskey="1" tabindex="-1">NCBI Homepage</a>
|
||
<a id="nws_header_accesskey_2" href="/myncbi/" class="set-base-url usa-sr-only" accesskey="2" tabindex="-1">MyNCBI Homepage</a>
|
||
<a id="nws_header_accesskey_3" href="#maincontent" class="usa-sr-only" accesskey="3" tabindex="-1">Main Content</a>
|
||
<a id="nws_header_accesskey_4" href="#" class="usa-sr-only" accesskey="4" tabindex="-1">Main Navigation</a>
|
||
</div>
|
||
<section data-section="Alerts">
|
||
<div class="ncbi-alerts-placeholder"></div>
|
||
</section>
|
||
</div>
|
||
<div class="header">
|
||
<div class="res_logo"><h1 class="res_name"><a href="/books/" title="Bookshelf home">Bookshelf</a></h1><h2 class="res_tagline"></h2></div>
|
||
<div class="search"><form method="get" action="/books/"><div class="search_form"><label for="database" class="offscreen_noflow">Search database</label><select id="database"><optgroup label="Recent"><option value="books" selected="selected" data-ac_dict="bookshelf-search">Books</option><option value="refseq">RefSeq</option><option value="nuccore">Nucleotide</option><option value="clinvar" class="last">ClinVar</option></optgroup><optgroup label="All"><option value="gquery">All Databases</option><option value="assembly">Assembly</option><option value="biocollections">Biocollections</option><option value="bioproject">BioProject</option><option value="biosample">BioSample</option><option value="books" data-ac_dict="bookshelf-search">Books</option><option value="clinvar">ClinVar</option><option value="cdd">Conserved Domains</option><option value="gap">dbGaP</option><option value="dbvar">dbVar</option><option value="gene">Gene</option><option value="genome">Genome</option><option value="gds">GEO DataSets</option><option value="geoprofiles">GEO Profiles</option><option value="gtr">GTR</option><option value="ipg">Identical Protein Groups</option><option value="medgen">MedGen</option><option value="mesh">MeSH</option><option value="nlmcatalog">NLM Catalog</option><option value="nuccore">Nucleotide</option><option value="omim">OMIM</option><option value="pmc">PMC</option><option value="protein">Protein</option><option value="proteinclusters">Protein Clusters</option><option value="protfam">Protein Family Models</option><option value="pcassay">PubChem BioAssay</option><option value="pccompound">PubChem Compound</option><option value="pcsubstance">PubChem Substance</option><option value="pubmed">PubMed</option><option value="snp">SNP</option><option value="sra">SRA</option><option value="structure">Structure</option><option value="taxonomy">Taxonomy</option><option value="toolkit">ToolKit</option><option value="toolkitall">ToolKitAll</option><option value="toolkitbookgh">ToolKitBookgh</option></optgroup></select><div class="nowrap"><label for="term" class="offscreen_noflow" accesskey="/">Search term</label><div class="nowrap"><input type="text" name="term" id="term" title="Search Books. Use up and down arrows to choose an item from the autocomplete." value="" class="jig-ncbiclearbutton jig-ncbiautocomplete" data-jigconfig="dictionary:'bookshelf-search',disableUrl:'NcbiSearchBarAutoComplCtrl'" autocomplete="off" data-sbconfig="ds:'no',pjs:'no',afs:'no'" /></div><button id="search" type="submit" class="button_search nowrap" cmd="go">Search</button></div></div></form><ul class="searchlinks inline_list"><li>
|
||
<a href="/books/browse/">Browse Titles</a>
|
||
</li><li>
|
||
<a href="/books/advanced/">Advanced</a>
|
||
</li><li class="help">
|
||
<a href="/books/NBK3833/">Help</a>
|
||
</li><li class="disclaimer">
|
||
<a target="_blank" data-ga-category="literature_resources" data-ga-action="link_click" data-ga-label="disclaimer_link" href="https://www.ncbi.nlm.nih.gov/books/about/disclaimer/">Disclaimer</a>
|
||
</li></ul></div>
|
||
</div>
|
||
|
||
|
||
|
||
<!--<component id="Page" label="headcontent"/>-->
|
||
|
||
</div>
|
||
<div class="content">
|
||
<!-- site messages -->
|
||
<!-- Custom content 1 -->
|
||
<div class="col1">
|
||
|
||
</div>
|
||
|
||
<div class="container">
|
||
<div id="maincontent" class="content eight_col col">
|
||
<!-- Custom content in the left column above book nav -->
|
||
<div class="col2">
|
||
|
||
</div>
|
||
|
||
<!-- Book content -->
|
||
|
||
|
||
<!-- Custom content between navigation and content -->
|
||
<div class="col3">
|
||
|
||
</div>
|
||
|
||
<div class="document">
|
||
<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/statpearls/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-statpearls-lrg.png" alt="Cover of StatPearls" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>StatPearls [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK603719_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK603719_dtls__"><div>Treasure Island (FL): <a href="https://www.statpearls.com/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">StatPearls Publishing</a>; 2025 Jan-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/statpearls/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
|
||
<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK603719_"><span class="title" itemprop="name">Mohs Micrographic Surgery Appropriate Use Criteria (AUC) Guidelines</span></h1><p class="contrib-group"><span itemprop="author">Fahad S. Siddiqui</span>; <span itemprop="author">Adam Leavitt</span>.</p><a data-jig="ncbitoggler" href="#__NBK603719_ai__" style="border:0;text-decoration:none">Author Information and Affiliations</a><div style="display:none" class="ui-widget" id="__NBK603719_ai__"><p class="contrib-group"><h4>Authors</h4><span itemprop="author">Fahad S. Siddiqui</span><sup>1</sup>; <span itemprop="author">Adam Leavitt</span><sup>2</sup>.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> Kansas City University/ADCS Dermatology Residency</div><div class="affiliation"><sup>2</sup> Kansas City University/ADCS Orlando</div></div><p class="small">Last Update: <span itemprop="dateModified">May 5, 2024</span>.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="article-149624.s1"><h2 id="_article-149624_s1_">Definition/Introduction</h2><p>Mohs micrographic surgery (MMS), named after Dr. Frederic Mohs, is a specialized tissue-sparing surgical technique for treating certain types of skin cancer. This procedure is renowned for its effectiveness in completely removing cancerous tissue while preserving as much healthy skin as possible. The surgeon performing this procedure can take little to no margin when removing cancer due to tissue mapping and full-margin analysis with a frozen section. Mohs surgery is particularly advantageous for skin cancers with indistinct clinical borders or those in critical areas, such as the face, where tissue preservation is crucial for cosmetic and functional reasons.<a class="bk_pop" href="#article-149624.r1">[1]</a></p><p>Due to increases in both skin cancer prevalence and the number of physicians trained in MMS, this method has been gaining popularity. From 1995 to 2009, it was estimated that the use of Mohs micrographic surgery increased by 400%.<a class="bk_pop" href="#article-149624.r2">[2]</a> As with any medical procedure, the appropriate use of MMS is guided by specific criteria to ensure its application in situations where its benefits are most pronounced. In 2012, the American Academy of Dermatology (AAD), American College of Mohs Surgery (ACMS), American Society for Dermatologic Surgery Association (ASDS), and American Society for Mohs Surgery (ASMS) collaborated to establish appropriate use criteria for 270 clinical scenarios for which MMS may be considered. In this study, 161 articles were identified, and an Ad Hoc Task Force completed the development of clinical indications for MMS. These indications were then rated for appropriateness for MMS by a panel of 8 Mohs surgeons and 9 non-Mohs dermatologists from varying backgrounds and practice settings. The ratings given were 1 to 3 (inappropriate), 4 to 6 (uncertain), and 7 to 9 (appropriate).<a class="bk_pop" href="#article-149624.r3">[3]</a></p><p>Cancer scenarios evaluated included 69 basal cell carcinomas (BCC), 143 squamous cell carcinomas (SCC), 12 lentigo maligna (LM)/melanoma in situ (MIS), and 46 other rare cutaneous malignancies. Ratings given to each scenario depended on several factors, including area of the body, immune status, genetic syndromes, prior radiation, positive margins, aggressive features, and recurrence.<a class="bk_pop" href="#article-149624.r3">[3]</a></p><p>Results of the 2012 MMS AUC study for BCC, SCC, LM, and MIS are summarized and are organized by type of skin cancer as well as area of the body (see <b>Table</b>. Summary of Mohs microsurgery AUC for Basal Cell Carcinoma, Squamous Cell Carcinoma, Lentigo Maligna, and Melanoma in situ). Area H represents central face, eyelids, eyebrows, nose, lips, chin, ear, periauricular skin/sulci, temples, genitalia, hands, feet, nail units, ankles, and the nipples/areola. Area M includes cheeks, forehead, scalp, neck, jawline, and pretibial surface. Area L includes the trunk and extremities (other than pretibial, acral areas, nail units, and ankles).<a class="bk_pop" href="#article-149624.r3">[3]</a> Boxes shaded green indicate “appropriate,” whereas yellow and red signify “uncertain” and “inappropriate,” respectively. Of the 270 evaluated scenarios, 74.07% were deemed appropriate, 8.89% uncertain, and 17.04% inappropriate.<a class="bk_pop" href="#article-149624.r3">[3]</a></p><p>In addition to the results displayed in the table, the AUC indicates that MMS is also appropriate for sebaceous carcinoma, mucinous carcinoma, microcystic adnexal carcinoma, malignant fibrous histiocytoma, leiomyosarcoma, extramammary Paget disease (EMPD), dermatofibrosarcoma protuberans (DFSP), atypical fibroxanthoma (AFX), apocrine/eccrine carcinoma, adnexal carcinoma, and adenocystic carcinoma, in all patient types and locations. For Merkel cell carcinoma (MCC), MMS is considered appropriate in areas H and M and uncertain in area L. MMS was also determined to be uncertain for desmoplastic trichoepithelioma in areas H and M, as well as angiosarcoma in all locations. MMS is inappropriate for desmoplastic trichoepithelioma in area L and Bowenoid papulosis in area H.<a class="bk_pop" href="#article-149624.r3">[3]</a></p></div><div id="article-149624.s2"><h2 id="_article-149624_s2_">Issues of Concern</h2><p>Concerns have been raised regarding the MMS AUC, particularly in the context of superficial basal cell carcinomas (sBCC). Steinman et al argue that many superficial BCCs scored as "appropriate" for Mohs surgery may be more appropriately categorized as "uncertain" or "inappropriate." This contention stems from primary superficial BCCs often exhibiting comparable cure rates when treated with alternative methods such as curettage and cryosurgery. Additionally, superficial BCCs are frequently multifocal, requiring more stages than other BCC types. The limited data on the risk for recurrence and invasion in sBCC cases further complicates the application of AUC.<a class="bk_pop" href="#article-149624.r4">[4]</a> Some challenge this push for reclassification of sBCC, asserting that many biopsied sBCCs may have evidence of more aggressive BCC subtypes on deeper sections, making MMS a useful treatment modality. In addition, it is mentioned that the need for more required stages for sBCC makes these tumors more well-suited to MMS. Finally, it is stated that appropriateness should not be misconstrued as a necessity. Although MMS may be appropriate for an sBCC, this does not negate the fact that other treatment modalities may also be appropriate.<a class="bk_pop" href="#article-149624.r5">[5]</a> The AUC represents minimal requirements and should not be used as a reason to perform MMS on every "appropriate" lesion.<a href="https://pubmed.ncbi.nlm.nih.gov/33894323" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">[6]</a> Skepticism extends to the geographical scope of the published AUC, as it solely considers publications from the United States, neglecting significant European trials.<a class="bk_pop" href="#article-149624.r6">[7]</a> Critiques also highlight the reliance on expert opinions rather than concrete evidence in determining AUC ratings.<a class="bk_pop" href="#article-149624.r6">[7]</a></p><p>While certain deviations from the AUC are accepted in specific scenarios, such as patient age or ill-defined margins, some authors underscore additional deviations practiced by Mohs surgeons, emphasizing the importance of clinical judgment. These authors identified that common reasons for performing MMS on "uncertain" or "inappropriate" tumors include multiple MMS procedures on the same day, lower leg lesions, and granulation into the adjacent wound.<a class="bk_pop" href="#article-149624.r7">[8]</a> Another study of 1,000 MMS patients revealed that the most common reason for performing MMS on "inappropriate" tumors was the treatment of an additional adjacent lesion in the same session.<a class="bk_pop" href="#article-149624.r8">[9]</a> Finally, certain discrepancies have been identified in the AUC. Specifically, a primary SCC in situ ≥ 2 cm in area L in a healthy patient is classified as "uncertain"; this classification appears to be counterintuitive. In addition, a primary sBCC in "area L" of any size in a patient with a genetic syndrome is classified as "appropriate", while a recurrent sBCC in "area L" of any size in the same patient is classified as "inappropriate".<a class="bk_pop" href="#article-149624.r9">[10]</a> These discrepancies and criticisms of the AUC may warrant further revision and reclassification of certain aspects of the AUC.</p><p>Over the past decade, there has been increasing concern regarding the overutilization of MMS and its financial implications due to the associated cost. Some argue that the Mohs AUC fuels increased utilization of MMS. Others emphasize that the AUC was established to identify tumors that are not appropriate for MMS, thereby minimizing inappropriate use.<a class="bk_pop" href="#article-149624.r10">[11]</a><a class="bk_pop" href="#article-149624.r11">[12]</a> A study of trends in MMS from 1995 to 2010 demonstrates that although the use of MMS is increasing, only about 10% of cutaneous malignancies are managed with this technique.<a class="bk_pop" href="#article-149624.r12">[13]</a> In addition, some argue that increased utilization is not the same as overutilization and that the former may be attributed to the increase in skin cancer diagnosis and increased access to MMS rather than the AUC.<a class="bk_pop" href="#article-149624.r13">[14]</a></p><p>Finally, it is important to remember that while the AUC establishes a score of MMS appropriateness for each scenario, it does not specify which other treatment modality may be most appropriate for each clinical scenario. This is because the choice of treatment is ultimately dependent on the practicing physician's clinical expertise as well as patient preferences. MMS being "appropriate" for a given scenario does not necessarily mean it is the best treatment for that patient.<a class="bk_pop" href="#article-149624.r14">[15]</a></p></div><div id="article-149624.s3"><h2 id="_article-149624_s3_">Clinical Significance</h2><p>Mohs AUC plays a pivotal role in guiding the judicious application of Mohs micrographic surgery and ensuring its clinical significance in dermatological oncology. The AUC, established to categorize cases by appropriateness for Mohs surgery, is instrumental in optimizing patient outcomes, resource utilization, and healthcare efficiency.</p><p>One of the primary clinical significances of Mohs AUC lies in patient selection. By systematically evaluating factors such as tumor type, size, location, and recurrence risk, the AUC assists healthcare providers in identifying cases where Mohs surgery is most likely to provide maximum benefits. This nuanced approach enables the allocation of this specialized and resource-intensive procedure to scenarios where its advantages in tissue preservation and high cure rates are most pronounced. The "Mohs Surgery Appropriate Use Criteria" mobile application, developed by the AAD, is a useful tool for providers to rapidly determine appropriateness regarding the use of MMS for a specific patient. The application allows you to select by cancer type, location, occurrence, and subtype, ultimately providing a median score of 1 to 9.</p><p>The AUC also offers a standardized framework for decision-making, fostering consistency in applying Mohs surgery across different clinical settings. This consistency is particularly crucial given the diverse skin cancers and individual patient variations. The AUC's role in minimizing unnecessary procedures is another key clinical significance. Not all skin cancers warrant the meticulous approach of Mohs surgery and the AUC safeguards against overutilization. By categorizing cases as "inappropriate" where alternative treatments may be more suitable, the AUC prevents unnecessary burdens on healthcare resources, reduces costs, and spares patients from undergoing procedures that may not offer additional clinical benefit. Conversely, the AUC also aids providers in categorizing tumors that do warrant Mohs surgery. Higher AUC scores are associated with significantly more stages taken during surgery.<a class="bk_pop" href="#article-149624.r15">[16]</a></p><p>The AUC also contributes to ongoing quality improvement in dermatologic surgery. Through continuous refinement based on emerging evidence and clinical experience, it should evolve to reflect the dynamic landscape of skin cancer management. This adaptability will ensure that Mohs surgery remains a relevant and effective option, incorporating advancements in diagnostic tools, therapeutic modalities, and understanding of skin cancer biology.</p></div><div id="article-149624.s4"><h2 id="_article-149624_s4_">Nursing, Allied Health, and Interprofessional Team Interventions</h2><p>Interprofessional collaboration is pivotal in healthcare, particularly in specialties like dermatology.<a class="bk_pop" href="#article-149624.r16">[17]</a> Mohs surgery, a highly effective treatment for skin cancer, requires a coordinated effort among various healthcare professionals to adhere to appropriate use criteria and provide patients with the best possible care and outcomes.</p><p>A study done in 2023 assessed ChatGPT's ability to appropriately categorize 22 surgical scenarios as "appropriate," "indeterminate," or "inappropriate" for MMS based on the AUC. The results demonstrated only a 68% congruence of ChatGPT with established Mohs AUC criteria.<a class="bk_pop" href="#article-149624.r17">[18]</a> This further emphasizes the importance of the human element and collaboration by qualified healthcare professionals to evaluate each patient on a case-by-case basis for appropriateness for MMS.</p><p>The interprofessional team involved in Mohs surgery may include dermatologists, Mohs surgeons, pathologists, advanced practice professionals, nurses, primary care physicians, and other allied healthcare professionals. Each member brings unique expertise and perspectives, facilitating comprehensive patient care. Dermatologists and Mohs surgeons use their clinical expertise to assess patients and determine the appropriateness of Mohs surgery based on the AUC. Pathologists play a crucial role in interpreting biopsy results and providing accurate diagnoses, which guide treatment decisions. Nurses and other allied healthcare professionals support patient care through pre-operative preparation, assistance during procedures, and post-operative follow-up.</p><p>Ethics also play a significant role in interprofessional collaboration, particularly concerning patient-centered care and shared decision-making. Healthcare professionals must prioritize patient well-being and autonomy, ensuring that treatment decisions align with the patient's preferences, values, and goals.<a class="bk_pop" href="#article-149624.r18">[19]</a> In addition, appropriate adherence to the Mohs AUC, combined with the provider's clinical judgment, prevents overutilization or underutilization of MMS.</p><p>Continuous education and training are essential components of interprofessional collaboration in Mohs surgery. Healthcare professionals must stay updated on the latest research, guidelines, and advancements in MMS to provide evidence-based care. Regular training sessions, workshops, and case reviews help ensure that team members have the knowledge and skills necessary to effectively adhere to Mohs AUC.</p></div><div id="article-149624.s5"><h2 id="_article-149624_s5_">Review Questions</h2><ul><li class="half_rhythm"><div>
|
||
<a href="https://www.statpearls.com/account/trialuserreg/?articleid=149624&utm_source=pubmed&utm_campaign=reviews&utm_content=149624" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Access free multiple choice questions on this topic.</a>
|
||
</div></li><li class="half_rhythm"><div>
|
||
<a href="https://www.statpearls.com/articlelibrary/commentarticle/149624/?utm_source=pubmed&utm_campaign=comments&utm_content=149624" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Comment on this article.</a>
|
||
</div></li></ul></div><div class="floats-group" id="article-149624.s6"><div class="iconblock whole_rhythm clearfix ten_col fig" id="figarticle149624imagef1" co-legend-rid="figlgndarticle149624imagef1"><a href="/books/NBK603719/figure/article-149624.image.f1/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figarticle149624imagef1" rid-ob="figobarticle149624imagef1"><img class="small-thumb" src="/books/NBK603719/bin/MMS__AUC__for__BCC.gif" src-large="/books/NBK603719/bin/MMS__AUC__for__BCC.jpg" alt="Table: Summary of Mohs Microsurgery AUC for Basal Cell Carcinoma, Squamous Cell Carcinoma, Lentigo Maligna, and Melanoma in Situ" /></a><div class="icnblk_cntnt" id="figlgndarticle149624imagef1"><h4 id="article-149624.image.f1"><a href="/books/NBK603719/figure/article-149624.image.f1/?report=objectonly" target="object" rid-ob="figobarticle149624imagef1">Figure</a></h4><p class="float-caption no_bottom_margin">Table: Summary of Mohs Microsurgery AUC for Basal Cell Carcinoma, Squamous Cell Carcinoma, Lentigo Maligna, and Melanoma in Situ. AAD/ACMS/ASDSA/ASMS Task Force; Connolly SM, Baker DR, et al. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs <a href="/books/NBK603719/figure/article-149624.image.f1/?report=objectonly" target="object" rid-ob="figobarticle149624imagef1">(more...)</a></p></div></div></div><div id="article-149624.s7"><h2 id="_article-149624_s7_">References</h2><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="article-149624.r1">Prickett KA, Ramsey ML. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Jul 25, 2023. Mohs Micrographic Surgery. [<a href="https://pubmed.ncbi.nlm.nih.gov/28722863" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28722863</span></a>]</div></dd><dt>2.</dt><dd><div class="bk_ref" id="article-149624.r2">Asgari MM, Olson JM, Alam M. Needs assessment for Mohs micrographic surgery. <span><span class="ref-journal">Dermatol Clin. </span>2012 Jan;<span class="ref-vol">30</span>(1):167-75, x.</span> [<a href="/pmc/articles/PMC3225895/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3225895</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22117877" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22117877</span></a>]</div></dd><dt>3.</dt><dd><div class="bk_ref" id="article-149624.r3">Ad Hoc Task Force. 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, 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. <span><span class="ref-journal">J Am Acad Dermatol. </span>2012 Oct;<span class="ref-vol">67</span>(4):531-50.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/22959232" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22959232</span></a>]</div></dd><dt>4.</dt><dd><div class="bk_ref" id="article-149624.r4">Steinman HK, Dixon A, Zachary CB. Reevaluating Mohs Surgery Appropriate Use Criteria for Primary Superficial Basal Cell Carcinoma. <span><span class="ref-journal">JAMA Dermatol. </span>2018 Jul 01;<span class="ref-vol">154</span>(7):755-756.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29516099" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29516099</span></a>]</div></dd><dt>5.</dt><dd><div class="bk_ref" id="article-149624.r5">MacFarlane DF, Perlis C. Mohs Appropriate Use Criteria for Superficial Basal Cell Carcinoma. <span><span class="ref-journal">JAMA Dermatol. </span>2019 Mar 01;<span class="ref-vol">155</span>(3):395-396.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30725085" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30725085</span></a>]</div></dd><dt>6.</dt><dd><div class="bk_ref" id="article-149624.r6">Kelleners-Smeets NW, Mosterd K. Comment on 2012 appropriate use criteria for Mohs micrographic surgery. <span><span class="ref-journal">J Am Acad Dermatol. </span>2013 Aug;<span class="ref-vol">69</span>(2):317-8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23866871" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23866871</span></a>]</div></dd><dt>7.</dt><dd><div class="bk_ref" id="article-149624.r7">Ruiz ES, Karia PS, Morgan FC, Liang CA, Schmults CD. Multiple Mohs micrographic surgery is the most common reason for divergence from the appropriate use criteria: A single institution retrospective cohort study. <span><span class="ref-journal">J Am Acad Dermatol. </span>2016 Oct;<span class="ref-vol">75</span>(4):830-831.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27646739" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27646739</span></a>]</div></dd><dt>8.</dt><dd><div class="bk_ref" id="article-149624.r8">Stancut E, Melvin OG, Griffin RL, Phillips CB, Huang CC. Institutional Adherence to Current Mohs Surgery Appropriate Use Criteria With Reasons for Nonadherence and Recommendations for Future Versions. <span><span class="ref-journal">Dermatol Surg. </span>2022 Mar 01;<span class="ref-vol">48</span>(3):290-292.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/35025848" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35025848</span></a>]</div></dd><dt>9.</dt><dd><div class="bk_ref" id="article-149624.r9">Croley JA, Joseph AK, Wagner RF. Discrepancies in the Mohs Micrographic Surgery appropriate use criteria. <span><span class="ref-journal">J Am Acad Dermatol. </span>2020 Feb;<span class="ref-vol">82</span>(2):e55.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30586610" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30586610</span></a>]</div></dd><dt>10.</dt><dd><div class="bk_ref" id="article-149624.r10">Blechman AB, Patterson JW, Russell MA. Application of Mohs micrographic surgery appropriate-use criteria to skin cancers at a university health system. <span><span class="ref-journal">J Am Acad Dermatol. </span>2014 Jul;<span class="ref-vol">71</span>(1):29-35.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24813300" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24813300</span></a>]</div></dd><dt>11.</dt><dd><div class="bk_ref" id="article-149624.r11">Coldiron B. Commentary: Implementation of the appropriate-use criteria will not increase Mohs micrographic surgery utilization. <span><span class="ref-journal">J Am Acad Dermatol. </span>2014 Jul;<span class="ref-vol">71</span>(1):36-7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24813301" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24813301</span></a>]</div></dd><dt>12.</dt><dd><div class="bk_ref" id="article-149624.r12">Reeder VJ, Gustafson CJ, Mireku K, Davis SA, Feldman SR, Pearce DJ. Trends in Mohs surgery from 1995 to 2010: an analysis of nationally representative data. <span><span class="ref-journal">Dermatol Surg. </span>2015 Mar;<span class="ref-vol">41</span>(3):397-403.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25705954" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25705954</span></a>]</div></dd><dt>13.</dt><dd><div class="bk_ref" id="article-149624.r13">Kantor J. Mohs Appropriate Use Criteria for Superficial Basal Cell Carcinoma. <span><span class="ref-journal">JAMA Dermatol. </span>2019 Mar 01;<span class="ref-vol">155</span>(3):395.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30725088" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30725088</span></a>]</div></dd><dt>14.</dt><dd><div class="bk_ref" id="article-149624.r14">Wong E, Axibal E, Brown M. Mohs Micrographic Surgery. <span><span class="ref-journal">Facial Plast Surg Clin North Am. </span>2019 Feb;<span class="ref-vol">27</span>(1):15-34.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30420068" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30420068</span></a>]</div></dd><dt>15.</dt><dd><div class="bk_ref" id="article-149624.r15">Hope RH, Dowdle TS, Hope L, Pruneda C. Mohs micrographic surgery for keratinocyte carcinomas: clinicopathological predictors of the number of stages. <span><span class="ref-journal">Proc (Bayl Univ Med Cent). </span>2023;<span class="ref-vol">36</span>(5):608-615.</span> [<a href="/pmc/articles/PMC10444016/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10444016</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/37614851" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37614851</span></a>]</div></dd><dt>16.</dt><dd><div class="bk_ref" id="article-149624.r16">Huber C. [Interprofessional Collaboration in Health Care]. <span><span class="ref-journal">Praxis (Bern 1994). </span>2022 Jan;<span class="ref-vol">110</span>(1):3-4.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/34983202" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34983202</span></a>]</div></dd><dt>17.</dt><dd><div class="bk_ref" id="article-149624.r17">O'Hern K, Yang E, Vidal NY. ChatGPT underperforms in triaging appropriate use of Mohs surgery for cutaneous neoplasms. <span><span class="ref-journal">JAAD Int. </span>2023 Sep;<span class="ref-vol">12</span>:168-170.</span> [<a href="/pmc/articles/PMC10316650/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10316650</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/37404248" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37404248</span></a>]</div></dd><dt>18.</dt><dd><div class="bk_ref" id="article-149624.r18">Wolz MM. Two become one: Ethics in dermatologic surgery. <span><span class="ref-journal">J Am Acad Dermatol. </span>2015 Jun;<span class="ref-vol">72</span>(6):1074-7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25981003" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25981003</span></a>]</div></dd></dl></div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_top_margin">
|
||
<b>Disclosure: </b>Fahad Siddiqui declares no relevant financial relationships with ineligible companies.</p></div></dd><dt></dt><dd><div><p class="no_top_margin">
|
||
<b>Disclosure: </b>Adam Leavitt declares no relevant financial relationships with ineligible companies.</p></div></dd></dl></div></div></div>
|
||
<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © 2025, StatPearls Publishing LLC.<p class="small">
|
||
This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
|
||
(<a href="https://creativecommons.org/licenses/by-nc-nd/4.0/" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=uri">
|
||
http://creativecommons.org/licenses/by-nc-nd/4.0/
|
||
</a>), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
|
||
</p></div><div class="small"><span class="label">Bookshelf ID: NBK603719</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/38753911" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">38753911</a></span></div></div></div>
|
||
|
||
</div>
|
||
|
||
<!-- Custom content below content -->
|
||
<div class="col4">
|
||
|
||
</div>
|
||
|
||
|
||
<!-- Book content -->
|
||
|
||
<!-- Custom contetnt below bottom nav -->
|
||
<div class="col5">
|
||
|
||
</div>
|
||
</div>
|
||
|
||
<div id="rightcolumn" class="four_col col last">
|
||
<!-- Custom content above discovery portlets -->
|
||
<div class="col6">
|
||
<div id="ncbi_share_book"><a href="#" class="ncbi_share" data-ncbi_share_config="popup:false,shorten:true" ref="id=NBK603719&db=books">Share</a></div>
|
||
|
||
</div>
|
||
<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK603719/?report=reader">PubReader</a></li><li><a href="/books/NBK603719/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK603719" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK603719" style="display:none" title="Cite this Page"><div class="bk_tt">Siddiqui FS, Leavitt A. Mohs Micrographic Surgery Appropriate Use Criteria (AUC) Guidelines. [Updated 2024 May 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. <span class="bk_cite_avail"></span></div></div></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#article-149624.s1" ref="log$=inpage&link_id=inpage">Definition/Introduction</a></li><li><a href="#article-149624.s2" ref="log$=inpage&link_id=inpage">Issues of Concern</a></li><li><a href="#article-149624.s3" ref="log$=inpage&link_id=inpage">Clinical Significance</a></li><li><a href="#article-149624.s4" ref="log$=inpage&link_id=inpage">Nursing, Allied Health, and Interprofessional Team Interventions</a></li><li><a href="#article-149624.s5" ref="log$=inpage&link_id=inpage">Review Questions</a></li><li><a href="#article-149624.s7" ref="log$=inpage&link_id=inpage">References</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Bulk Download</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="https://ftp.ncbi.nlm.nih.gov/pub/litarch/3d/12/" ref="pagearea=source-links&targetsite=external&targetcat=link&targettype=uri">Bulk download StatPearls data from FTP</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related information</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="discovery_db_links" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper"><a class="brieflinkpopperctrl" href="/books/?Db=pmc&DbFrom=books&Cmd=Link&LinkName=books_pmc_refs&IdsFromResult=5623754" ref="log$=recordlinks">PMC</a><div class="brieflinkpop offscreen_noflow">PubMed Central citations</div></li><li class="brieflinkpopper"><a class="brieflinkpopperctrl" href="/books/?Db=pubmed&DbFrom=books&Cmd=Link&LinkName=books_pubmed_refs&IdsFromResult=5623754" ref="log$=recordlinks">PubMed</a><div class="brieflinkpop offscreen_noflow">Links to PubMed</div></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/39383285" ref="ordinalpos=1&linkpos=1&log$=relatedarticles&logdbfrom=pubmed">Mohs Micrographic Surgery Section of Specimens Using Cryostat, Stain, and Immunostain.</a><span class="source">[StatPearls. 2025]</span><div class="brieflinkpop offscreen_noflow">Mohs Micrographic Surgery Section of Specimens Using Cryostat, Stain, and Immunostain.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Wong A, Dunn C. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">StatPearls. 2025 Jan</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/39650795" ref="ordinalpos=1&linkpos=2&log$=relatedarticles&logdbfrom=pubmed">Far Posterior Approach for Rib Fracture Fixation: Surgical Technique and Tips.</a><span class="source">[JBJS Essent Surg Tech. 2024]</span><div class="brieflinkpop offscreen_noflow">Far Posterior Approach for Rib Fracture Fixation: Surgical Technique and Tips.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Manes TJ, DeGenova DT, Taylor BC, Patel JN. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">JBJS Essent Surg Tech. 2024 Oct-Dec; 14(4). Epub 2024 Dec 6.</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/39163439" ref="ordinalpos=1&linkpos=3&log$=relatedarticles&logdbfrom=pubmed">Mohs Micrographic Surgery Management of Melanoma and Melanoma In Situ.</a><span class="source">[StatPearls. 2025]</span><div class="brieflinkpop offscreen_noflow">Mohs Micrographic Surgery Management of Melanoma and Melanoma In Situ.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Verma K, Lewis DJ, Siddiqui FS, Dane A. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">StatPearls. 2025 Jan</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/36137063" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Depressing time: Waiting, melancholia, and the psychoanalytic practice of care.</a><span class="source">[The Time of Anthropology: Stud...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Depressing time: Waiting, melancholia, and the psychoanalytic practice of care.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Salisbury L, Baraitser L. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">The Time of Anthropology: Studies of Contemporary Chronopolitics. 2020</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/20301510" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> FBN1-Related Marfan Syndrome.</a><span class="source">[GeneReviews(®). 1993]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> FBN1-Related Marfan Syndrome.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Dietz H. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">GeneReviews(®). 1993</em></div></div></li></ul><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed_reviews&uid=38753911" ref="ordinalpos=1&log$=relatedreviews_seeall&logdbfrom=pubmed">See reviews...</a><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=38753911" ref="ordinalpos=1&log$=relatedarticles_seeall&logdbfrom=pubmed">See all...</a></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Recent Activity</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="recent_activity" id="Shutter"></a></div><div class="portlet_content"><div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" id="HTDisplay" class=""><div class="action"><a href="javascript:historyDisplayState('ClearHT')">Clear</a><a href="javascript:historyDisplayState('HTOff')" class="HTOn">Turn Off</a><a href="javascript:historyDisplayState('HTOn')" class="HTOff">Turn On</a></div><ul id="activity"><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=1" href="/portal/utils/pageresolver.fcgi?recordid=67c80addb70fbb196025cbf0">Mohs Micrographic Surgery Appropriate Use Criteria (AUC) Guidelines - StatPearls</a><div class="ralinkpop offscreen_noflow">Mohs Micrographic Surgery Appropriate Use Criteria (AUC) Guidelines - StatPearls<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=2" href="/portal/utils/pageresolver.fcgi?recordid=67c80adcfeee5b00ac20e7d9">Pecto-Intercostal Fascial Plane Block - StatPearls</a><div class="ralinkpop offscreen_noflow">Pecto-Intercostal Fascial Plane Block - StatPearls<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=3" href="/portal/utils/pageresolver.fcgi?recordid=67c80adc6d1ec11b6f801453">Topical Steroid Withdrawal (Red Skin Syndrome) - StatPearls</a><div class="ralinkpop offscreen_noflow">Topical Steroid Withdrawal (Red Skin Syndrome) - StatPearls<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=4" href="/portal/utils/pageresolver.fcgi?recordid=67c80adafeee5b00ac20da22">Laboratory Evaluation of Bone Marrow - StatPearls</a><div class="ralinkpop offscreen_noflow">Laboratory Evaluation of Bone Marrow - StatPearls<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=5" href="/portal/utils/pageresolver.fcgi?recordid=67c80ad9b70fbb1960259f4c">Nuclear Medicine CNS Assessment, Protocols, and Interpretation - StatPearls</a><div class="ralinkpop offscreen_noflow">Nuclear Medicine CNS Assessment, Protocols, and Interpretation - StatPearls<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li></ul><p class="HTOn">Your browsing activity is empty.</p><p class="HTOff">Activity recording is turned off.</p><p id="turnOn" class="HTOff"><a href="javascript:historyDisplayState('HTOn')">Turn recording back on</a></p><a class="seemore" href="/sites/myncbi/recentactivity">See more...</a></div></div></div>
|
||
|
||
<!-- Custom content below discovery portlets -->
|
||
<div class="col7">
|
||
|
||
</div>
|
||
</div>
|
||
</div>
|
||
|
||
<!-- Custom content after all -->
|
||
<div class="col8">
|
||
|
||
</div>
|
||
<div class="col9">
|
||
|
||
</div>
|
||
|
||
<script type="text/javascript" src="/corehtml/pmc/js/jquery.scrollTo-1.4.2.js"></script>
|
||
<script type="text/javascript">
|
||
(function($){
|
||
$('.skiplink').each(function(i, item){
|
||
var href = $($(item).attr('href'));
|
||
href.attr('tabindex', '-1').addClass('skiptarget'); // ensure the target can receive focus
|
||
$(item).on('click', function(event){
|
||
event.preventDefault();
|
||
$.scrollTo(href, 0, {
|
||
onAfter: function(){
|
||
href.focus();
|
||
}
|
||
});
|
||
});
|
||
});
|
||
})(jQuery);
|
||
</script>
|
||
</div>
|
||
<div class="bottom">
|
||
<script type="text/javascript">
|
||
var PBooksSearchTermData = {
|
||
highlighter: "bold",
|
||
dateTime: "03/05/2025 03:12:13",
|
||
terms: [
|
||
'2010'
|
||
]
|
||
};
|
||
</script>
|
||
<div id="NCBIFooter_dynamic">
|
||
<!--<component id="Breadcrumbs" label="breadcrumbs"/>
|
||
<component id="Breadcrumbs" label="helpdesk"/>-->
|
||
|
||
</div>
|
||
|
||
<div class="footer" id="footer">
|
||
<section class="icon-section">
|
||
<div id="icon-section-header" class="icon-section_header">Follow NCBI</div>
|
||
<div class="grid-container container">
|
||
<div class="icon-section_container">
|
||
<a class="footer-icon" id="footer_twitter" href="https://twitter.com/ncbi" aria-label="Twitter"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
||
<defs>
|
||
<style>
|
||
.cls-11 {
|
||
fill: #737373;
|
||
}
|
||
</style>
|
||
</defs>
|
||
<title>Twitter</title>
|
||
<path class="cls-11" d="M250.11,105.48c-7,3.14-13,3.25-19.27.14,8.12-4.86,8.49-8.27,11.43-17.46a78.8,78.8,0,0,1-25,9.55,39.35,39.35,0,0,0-67,35.85,111.6,111.6,0,0,1-81-41.08A39.37,39.37,0,0,0,81.47,145a39.08,39.08,0,0,1-17.8-4.92c0,.17,0,.33,0,.5a39.32,39.32,0,0,0,31.53,38.54,39.26,39.26,0,0,1-17.75.68,39.37,39.37,0,0,0,36.72,27.3A79.07,79.07,0,0,1,56,223.34,111.31,111.31,0,0,0,116.22,241c72.3,0,111.83-59.9,111.83-111.84,0-1.71,0-3.4-.1-5.09C235.62,118.54,244.84,113.37,250.11,105.48Z">
|
||
</path>
|
||
</svg></a>
|
||
<a class="footer-icon" id="footer_facebook" href="https://www.facebook.com/ncbi.nlm" aria-label="Facebook"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
||
<title>Facebook</title>
|
||
<path class="cls-11" d="M210.5,115.12H171.74V97.82c0-8.14,5.39-10,9.19-10h27.14V52l-39.32-.12c-35.66,0-42.42,26.68-42.42,43.77v19.48H99.09v36.32h27.24v109h45.41v-109h35Z">
|
||
</path>
|
||
</svg></a>
|
||
<a class="footer-icon" id="footer_linkedin" href="https://www.linkedin.com/company/ncbinlm" aria-label="LinkedIn"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
||
<title>LinkedIn</title>
|
||
<path class="cls-11" d="M101.64,243.37H57.79v-114h43.85Zm-22-131.54h-.26c-13.25,0-21.82-10.36-21.82-21.76,0-11.65,8.84-21.15,22.33-21.15S101.7,78.72,102,90.38C102,101.77,93.4,111.83,79.63,111.83Zm100.93,52.61A17.54,17.54,0,0,0,163,182v61.39H119.18s.51-105.23,0-114H163v13a54.33,54.33,0,0,1,34.54-12.66c26,0,44.39,18.8,44.39,55.29v58.35H198.1V182A17.54,17.54,0,0,0,180.56,164.44Z">
|
||
</path>
|
||
</svg></a>
|
||
<a class="footer-icon" id="footer_github" href="https://github.com/ncbi" aria-label="GitHub"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
||
<defs>
|
||
<style>
|
||
.cls-11,
|
||
.cls-12 {
|
||
fill: #737373;
|
||
}
|
||
|
||
.cls-11 {
|
||
fill-rule: evenodd;
|
||
}
|
||
</style>
|
||
</defs>
|
||
<title>GitHub</title>
|
||
<path class="cls-11" d="M151.36,47.28a105.76,105.76,0,0,0-33.43,206.1c5.28,1,7.22-2.3,7.22-5.09,0-2.52-.09-10.85-.14-19.69-29.42,6.4-35.63-12.48-35.63-12.48-4.81-12.22-11.74-15.47-11.74-15.47-9.59-6.56.73-6.43.73-6.43,10.61.75,16.21,10.9,16.21,10.9,9.43,16.17,24.73,11.49,30.77,8.79,1-6.83,3.69-11.5,6.71-14.14C108.57,197.1,83.88,188,83.88,147.51a40.92,40.92,0,0,1,10.9-28.39c-1.1-2.66-4.72-13.42,1-28,0,0,8.88-2.84,29.09,10.84a100.26,100.26,0,0,1,53,0C198,88.3,206.9,91.14,206.9,91.14c5.76,14.56,2.14,25.32,1,28a40.87,40.87,0,0,1,10.89,28.39c0,40.62-24.74,49.56-48.29,52.18,3.79,3.28,7.17,9.71,7.17,19.58,0,14.15-.12,25.54-.12,29,0,2.82,1.9,6.11,7.26,5.07A105.76,105.76,0,0,0,151.36,47.28Z">
|
||
</path>
|
||
<path class="cls-12" d="M85.66,199.12c-.23.52-1.06.68-1.81.32s-1.2-1.06-.95-1.59,1.06-.69,1.82-.33,1.21,1.07.94,1.6Zm-1.3-1">
|
||
</path>
|
||
<path class="cls-12" d="M90,203.89c-.51.47-1.49.25-2.16-.49a1.61,1.61,0,0,1-.31-2.19c.52-.47,1.47-.25,2.17.49s.82,1.72.3,2.19Zm-1-1.08">
|
||
</path>
|
||
<path class="cls-12" d="M94.12,210c-.65.46-1.71,0-2.37-.91s-.64-2.07,0-2.52,1.7,0,2.36.89.65,2.08,0,2.54Zm0,0"></path>
|
||
<path class="cls-12" d="M99.83,215.87c-.58.64-1.82.47-2.72-.41s-1.18-2.06-.6-2.7,1.83-.46,2.74.41,1.2,2.07.58,2.7Zm0,0">
|
||
</path>
|
||
<path class="cls-12" d="M107.71,219.29c-.26.82-1.45,1.2-2.64.85s-2-1.34-1.74-2.17,1.44-1.23,2.65-.85,2,1.32,1.73,2.17Zm0,0">
|
||
</path>
|
||
<path class="cls-12" d="M116.36,219.92c0,.87-1,1.59-2.24,1.61s-2.29-.68-2.3-1.54,1-1.59,2.26-1.61,2.28.67,2.28,1.54Zm0,0">
|
||
</path>
|
||
<path class="cls-12" d="M124.42,218.55c.15.85-.73,1.72-2,1.95s-2.37-.3-2.52-1.14.73-1.75,2-2,2.37.29,2.53,1.16Zm0,0"></path>
|
||
</svg></a>
|
||
<a class="footer-icon" id="footer_blog" href="https://ncbiinsights.ncbi.nlm.nih.gov/" aria-label="Blog">
|
||
<svg xmlns="http://www.w3.org/2000/svg" id="Layer_1" data-name="Layer 1" viewBox="0 0 40 40">
|
||
<defs><style>.cls-1{fill:#737373;}</style></defs>
|
||
<title>NCBI Insights Blog</title>
|
||
<path class="cls-1" d="M14,30a4,4,0,1,1-4-4,4,4,0,0,1,4,4Zm11,3A19,19,0,0,0,7.05,15a1,1,0,0,0-1,1v3a1,1,0,0,0,.93,1A14,14,0,0,1,20,33.07,1,1,0,0,0,21,34h3a1,1,0,0,0,1-1Zm9,0A28,28,0,0,0,7,6,1,1,0,0,0,6,7v3a1,1,0,0,0,1,1A23,23,0,0,1,29,33a1,1,0,0,0,1,1h3A1,1,0,0,0,34,33Z"></path>
|
||
</svg>
|
||
</a>
|
||
</div>
|
||
</div>
|
||
</section>
|
||
|
||
<section class="container-fluid bg-primary">
|
||
<div class="container pt-5">
|
||
<div class="row mt-3">
|
||
<div class="col-lg-3 col-12">
|
||
<p><a class="text-white" href="https://www.nlm.nih.gov/socialmedia/index.html">Connect with NLM</a></p>
|
||
<ul class="list-inline social_media">
|
||
<li class="list-inline-item"><a href="https://twitter.com/NLM_NIH" aria-label="Twitter" target="_blank" rel="noopener noreferrer"><svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
||
<style type="text/css">
|
||
.st20 {
|
||
fill: #FFFFFF;
|
||
}
|
||
|
||
.st30 {
|
||
fill: none;
|
||
stroke: #FFFFFF;
|
||
stroke-width: 8;
|
||
stroke-miterlimit: 10;
|
||
}
|
||
</style>
|
||
<title>Twitter</title>
|
||
<g>
|
||
<g>
|
||
<g>
|
||
<path class="st20" d="M192.9,88.1c-5,2.2-9.2,2.3-13.6,0.1c5.7-3.4,6-5.8,8.1-12.3c-5.4,3.2-11.4,5.5-17.6,6.7 c-10.5-11.2-28.1-11.7-39.2-1.2c-7.2,6.8-10.2,16.9-8,26.5c-22.3-1.1-43.1-11.7-57.2-29C58,91.6,61.8,107.9,74,116 c-4.4-0.1-8.7-1.3-12.6-3.4c0,0.1,0,0.2,0,0.4c0,13.2,9.3,24.6,22.3,27.2c-4.1,1.1-8.4,1.3-12.5,0.5c3.6,11.3,14,19,25.9,19.3 c-11.6,9.1-26.4,13.2-41.1,11.5c12.7,8.1,27.4,12.5,42.5,12.5c51,0,78.9-42.2,78.9-78.9c0-1.2,0-2.4-0.1-3.6 C182.7,97.4,189.2,93.7,192.9,88.1z"></path>
|
||
</g>
|
||
</g>
|
||
<circle class="st30" cx="124.4" cy="128.8" r="108.2"></circle>
|
||
</g>
|
||
</svg></a></li>
|
||
<li class="list-inline-item"><a href="https://www.facebook.com/nationallibraryofmedicine" aria-label="Facebook" rel="noopener noreferrer" target="_blank">
|
||
<svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
||
<style type="text/css">
|
||
.st10 {
|
||
fill: #FFFFFF;
|
||
}
|
||
|
||
.st110 {
|
||
fill: none;
|
||
stroke: #FFFFFF;
|
||
stroke-width: 8;
|
||
stroke-miterlimit: 10;
|
||
}
|
||
</style>
|
||
<title>Facebook</title>
|
||
<g>
|
||
<g>
|
||
<path class="st10" d="M159,99.1h-24V88.4c0-5,3.3-6.2,5.7-6.2h16.8V60l-24.4-0.1c-22.1,0-26.2,16.5-26.2,27.1v12.1H90v22.5h16.9 v67.5H135v-67.5h21.7L159,99.1z"></path>
|
||
</g>
|
||
</g>
|
||
<circle class="st110" cx="123.6" cy="123.2" r="108.2"></circle>
|
||
</svg>
|
||
</a></li>
|
||
<li class="list-inline-item"><a href="https://www.youtube.com/user/NLMNIH" aria-label="Youtube" target="_blank" rel="noopener noreferrer"><svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
||
<title>Youtube</title>
|
||
<style type="text/css">
|
||
.st4 {
|
||
fill: none;
|
||
stroke: #FFFFFF;
|
||
stroke-width: 8;
|
||
stroke-miterlimit: 10;
|
||
}
|
||
|
||
.st5 {
|
||
fill: #FFFFFF;
|
||
}
|
||
</style>
|
||
<circle class="st4" cx="124.2" cy="123.4" r="108.2"></circle>
|
||
<g transform="translate(0,-952.36218)">
|
||
<path class="st5" d="M88.4,1037.4c-10.4,0-18.7,8.3-18.7,18.7v40.1c0,10.4,8.3,18.7,18.7,18.7h72.1c10.4,0,18.7-8.3,18.7-18.7 v-40.1c0-10.4-8.3-18.7-18.7-18.7H88.4z M115.2,1058.8l29.4,17.4l-29.4,17.4V1058.8z"></path>
|
||
</g>
|
||
</svg></a></li>
|
||
</ul>
|
||
</div>
|
||
<div class="col-lg-3 col-12">
|
||
<p class="address_footer text-white">National Library of Medicine<br />
|
||
<a href="https://www.google.com/maps/place/8600+Rockville+Pike,+Bethesda,+MD+20894/@38.9959508,-77.101021,17z/data=!3m1!4b1!4m5!3m4!1s0x89b7c95e25765ddb:0x19156f88b27635b8!8m2!3d38.9959508!4d-77.0988323" class="text-white" target="_blank" rel="noopener noreferrer">8600 Rockville Pike<br />
|
||
Bethesda, MD 20894</a></p>
|
||
</div>
|
||
<div class="col-lg-3 col-12 centered-lg">
|
||
<p><a href="https://www.nlm.nih.gov/web_policies.html" class="text-white">Web Policies</a><br />
|
||
<a href="https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/freedom-information-act-office" class="text-white">FOIA</a><br />
|
||
<a href="https://www.hhs.gov/vulnerability-disclosure-policy/index.html" class="text-white" id="vdp">HHS Vulnerability Disclosure</a></p>
|
||
</div>
|
||
<div class="col-lg-3 col-12 centered-lg">
|
||
<p><a class="supportLink text-white" href="https://support.nlm.nih.gov/">Help</a><br />
|
||
<a href="https://www.nlm.nih.gov/accessibility.html" class="text-white">Accessibility</a><br />
|
||
<a href="https://www.nlm.nih.gov/careers/careers.html" class="text-white">Careers</a></p>
|
||
</div>
|
||
</div>
|
||
<div class="row">
|
||
<div class="col-lg-12 centered-lg">
|
||
<nav class="bottom-links">
|
||
<ul class="mt-3">
|
||
<li>
|
||
<a class="text-white" href="//www.nlm.nih.gov/">NLM</a>
|
||
</li>
|
||
<li>
|
||
<a class="text-white" href="https://www.nih.gov/">NIH</a>
|
||
</li>
|
||
<li>
|
||
<a class="text-white" href="https://www.hhs.gov/">HHS</a>
|
||
</li>
|
||
<li>
|
||
<a class="text-white" href="https://www.usa.gov/">USA.gov</a>
|
||
</li>
|
||
</ul>
|
||
</nav>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</section>
|
||
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentOmnitureBaseJS/InstrumentNCBIConfigJS/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js?v=1"> </script>
|
||
<script type="text/javascript" src="/portal/portal3rc.fcgi/static/js/hfjs2.js"> </script>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<!--/.page-->
|
||
</div>
|
||
<!--/.wrap-->
|
||
</div><!-- /.twelve_col -->
|
||
</div>
|
||
<!-- /.grid -->
|
||
|
||
<span class="PAFAppResources"></span>
|
||
|
||
<!-- BESelector tab -->
|
||
|
||
|
||
|
||
<noscript><img alt="statistics" src="/stat?jsdisabled=true&ncbi_db=books&ncbi_pdid=book-part&ncbi_acc=NBK603719&ncbi_domain=statpearls&ncbi_report=record&ncbi_type=fulltext&ncbi_objectid=&ncbi_pcid=/NBK603719/&ncbi_pagename=Mohs Micrographic Surgery Appropriate Use Criteria (AUC) Guidelines - StatPearls - NCBI Bookshelf&ncbi_bookparttype=chapter&ncbi_app=bookshelf" /></noscript>
|
||
|
||
|
||
<!-- usually for JS scripts at page bottom -->
|
||
<!--<component id="PageFixtures" label="styles"></component>-->
|
||
|
||
|
||
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal107 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
||
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
||
|
||
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3879255/4121861/3501987/4008961/3893018/3821238/4062932/4209313/4212053/4076480/3921943/3400083/3426610.js" snapshot="books"></script></body>
|
||
</html> |