Mohs Surgery - Where Mohs Surgery Is Allowed

Where Mohs Surgery Is Allowed

An example where clinical guidelines are issued by insurance companies; these guidelines are not indication that Mohs is the best method for the cancers described. These guidelines are subjective (why is younger than 40 years old a criterion?), and might not have any clear objective basis. Clinical guidelines currently adapted by Medicare insurance of the United States:

Medicare will cover reimbursement for Mohs micrographic surgery for accepted diagnoses and indications as listed below.

1. Basal Cell, Squamous Cell, or Basalosquamous Cell Carcinomas in anatomic locations where they are prone to recur:
   • Central facial areas, periauricular, nose, and temple areas of the face (the so-called "mask area" of the face)
   • Lips, cutaneous and vermilion
   • Eyelids and periorbital areas
   • Auricular helix and canal
   • Chin and mandible
2. Other Skin lesions:
   • Angiosarcoma of the skin
   • Keratoacanthoma, recurrent
   • Dermatofibrosarcoma protuberans
   • Malignant fibrous histiocytoma
   • Sebaceous gland carcinoma
   • Microcystic adnexal carcinoma
   • Extramammary Paget's disease
   • Bowenoid papulosis
   • Merkel cell carcinoma
   • Bowen's disease (squamous cell carcinoma in situ)
   • Adenoid type of squamous cell carcinoma
   • Rapid growth in a squamous cell carcinoma
   • Longstanding duration of a squamous cell carcinoma
   • Verrucous carcinoma
   • Atypical Fibroxanthoma
   • Leiomyosarcoma or other spindle cell neoplasms of the skin
   • Adenocystic carcinoma of the skin
   • Erythroplasia of Queryrat
   • Oral and central facial, paranasal sinus neoplasm
   • Apocrine carcinoma of the skin
   • Malignant melanoma (facial, auricular, genital and digital) when anatomical or technical – difficulties do not allow conventional excision with appropriate margins.
   • Basal Cell carcinomas, squamous cell carcinomas, or basalosquamous carcinomas that have one or more of the following features:
     • Recurrent
     • Aggressive pathology in the following areas: Hands and feet, Genitalia, and Nail unit/periungual
     • Large size (2.0 cm or greater)
     • Positive margins on recent excision
     • Poorly defined borders
     • In the very young (<40 years age)
     • Radiation-induced
     • In patients with proven difficulty with skin cancers or who are immunocompromised
     • Basal cell nevus syndrome
     • In an old scar (e.g., a Marjolin's ulcer)
     • Associated with xeroderma pigmentosum
     • Perineural invasion on biopsy
     • Deeply infiltrating lesion or difficulty estimating depth of lesion
3. Laryngeal Carcinoma