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To Mohs or not to Mohs

Considering the Elderly Patient

Journal of the Dermatology Nurses' Association: March/April 2019 - Volume 11 - Issue 2 - p E1–E2
doi: 10.1097/JDN.0000000000000460
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Back to Top | Article Outline


PURPOSE: To present a comprehensive review of Mohs micrographic surgery for treating non-melanoma skin cancers, while also exploring its appropriateness for elderly patients.

LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be able to:

1. Recall the background information about non-melanoma skin cancers and the use of Mohs micrographic surgery for treating them.

2. Identify the issues and relevant research surrounding the use of Mohs micrographic surgery for treating elderly patients’ non-melanoma skin cancers.

  1. A University of California San Francisco (UCSF) study found that most of the non-melanoma skin cancers of the patients in the study sample were treated surgically regardless of the potential harm from the tumor or the patient’s
    1. comorbidities.
    2. life expectancy.
    3. genetic predisposition.
  2. One in five of the patients from the UCSF study sample reported a complication from surgery, including pain, bleeding, poor wound healing, or
    1. itching.
    2. wound infection.
    3. excessive scarring.
  3. About half of the elderly patients from the UCSF study who had comorbidities and functional limitations died within five years of treatment from
    1. cancer.
    2. complications of treatment.
    3. non-related complications.
  4. Of the following methods of skin cancer treatment, which is the most expensive?
    1. surgical excision
    2. Mohs micrographic surgery (MMS)
    3. electrodesiccation and curettage
  5. According to the American Cancer Society, the most common type of skin cancer is
    1. basal cell carcinoma (BCC).
    2. squamous cell carcinoma (SCC).
    3. malignant melanoma.
  6. Which of the following is a characteristic of BCCs?
    1. They grow rapidly.
    2. They are more likely than SCCs to grow deep beneath the skin.
    3. They have the potential to invade bone and other tissues beneath the skin.
  7. Which of the following features describes MMS?
    1. It requires a surgeon and a pathologist to work simultaneously.
    2. It is the gold standard of care for the removal of complex skin cancers.
    3. It allows histological examination of about 90% of the surgical margins.
  8. One of the patient characteristics included in the appropriate use criteria (AUC) for MMS scoring is
    1. immunosuppression.
    2. psychosocial health.
    3. specific preferences.
  9. Mohs AUC, an interactive application tool, allows providers to determine an AUC score, but does not factor in any consideration of the patient’s
    1. health.
    2. physical ability.
    3. specific cancer type.
  10. Which of the following methods of treating BCC and SCC tumors has the highest cure rate?
    1. MMS
    2. surgical excision
    3. electrodesiccation and curettage
  11. A key difference between Mohs surgery and excisional surgery is that Mohs
    1. takes longer for pathology results.
    2. requires more tissue sampling.
    3. is done in stages.
  12. Study results by Merritt et al. (2012) reported that only 2.6% of MMS patients developed minor complications during the study, one of which was postoperative
    1. nausea.
    2. bleeding.
    3. restlessness.
  13. A retrospective study by Delaney et al. (2013) assessing the safety of MMS for patients 90 years or older demonstrated that
    1. none of the patients developed complications from the surgery.
    2. postoperative pain levels averaged about 3 on a 0 to 10 scale.
    3. the Charlson index score accurately predicted survival rates.
  14. Delaney et al. (2013) reported that tumor size, number of stages, and closure types did not affect
    1. survival times.
    2. tumor recurrence.
    3. postoperative pain.
  15. In a study by Camarero-Mulas (2017) of an older group and a younger group of patients undergoing MMS, it was found that the patients in the older group usually
    1. had smaller tumor sizes.
    2. had deeper tumor invasion.
    3. required less procedural time.
  16. Camarero-Mulas (2017) concluded that MMS is
    1. safer for the younger population than it is for the elderly population.
    2. safer for the elderly population than it is for the younger population.
    3. just as safe for the elderly population as it is for the younger population.
Copyright © 2019 by the Dermatology Nurses' Association.