Kennebec Region Health Alliance

I. Background:

Mohs surgery is a specialized form of skin cancer surgery that maximizes tissue preservation and offers high cure rates. In general, it is an excellent option for non-melanoma skin cancer (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinomas (SCC), and is the gold standard for NMSC lesions that meet specific criteria, such as those that are either larger in size, located on the head and neck, recurrent, aggressive on pathology, or clinically hard to delineate.

Insight into more specific criteria for Mohs referral can be found in the NCCN guidelines. The Mohs Appropriate-Use Criteria (Mohs AUC) Application, available for download to your smart device, is an easy-to-use alternative to interpreting the NCCN guidelines and can easily determine whether a lesion is appropriate for Mohs referral. Patients can also be referred to general dermatology with skin lesions either clinically suspicious for, or biopsy-proven as NMSC, to be triaged to receive the most appropriate care based on the information included in the referral.

II. Referring for Mohs Surgery:

a. Pathology Report:

i. Direct referral to Mohs surgery requires a biopsy-proven skin cancer amenable to Mohs surgery.

1. If a lesion is in an area you are unable to biopsy consider referral to general dermatology, plastic surgery, or ENT for evaluation and biopsy.

b. Photograph:

i. Lesion-site identification is required

1. It is recommended that a photograph be taken of the lesion and included with the referral.

2. Alternatively, a patient may take a photo with their phone to bring to the visit. Photographs should include nearby structures to help locate the tumor—biopsy sites often heal very well!

c. Other decision-making considerations:

i. If you are unsure about the best treatment of any lesion, referral to general dermatology or phone call to discuss are always an option.

1. If the lesion is NMSC, and you are wondering about Mohs, consider using the Mohs AUC app

2. For pigmented lesions (ex. suspected melanoma), Mohs may or may not be the most appropriate therapy and referral to general dermatology is often preferred.

3. If you suspect a lesion needs treatment urgently, please call dermatology