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Multicenter Study
. 2025 Jan;92(1):85-91.
doi: 10.1016/j.jaad.2024.08.073. Epub 2024 Sep 20.

How dermatologic surgeons decide to proceed with surgery for nonmelanoma skin cancer when site identification is initially uncertain: A nationwide, multicenter, prospective study

Areeba Ahmed  1 , Amanda Maisel-Campbell  2 , Victoria J Shi  1 , Eric Koza  1 , Melissa Ma  1 , Misha Haq  1 , Umer Nadir  1 , Michael D Yi  1 , Loma Dave  1 , Farhana Ikmal Hisham  1 , Katherine A Lin  1 , Sarah A Ibrahim  1 , Bianca Y Kang  1 , McKenzie A Dirr  1 , Juliet L Aylward  3 , Omar Bari  4 , Hamza Bhatti  5 , Diana Bolotin  6 , Basil S Cherpelis  7 , Joel L Cohen  8 , Sean Condon  9 , Sheila Farhang  10 , Bahar Firoz  11 , Algin B Garrett  12 , Roy G Geronemus  13 , Nicholas J Golda  14 , Dyann Helming  14 , Tatyana R Humphreys  15 , Eva A Hurst  16 , Oren H Jacobson  17 , S Brian Jiang  18 , Pritesh S Karia  19 , Arash Kimyai-Asadi  20 , David J Kouba  21 , M Laurin Council  22 , Marilyn Le  23 , Deborah F MacFarlane  24 , Ian A Maher  25 , Stanley J Miller  26 , Eduardo K Moioli  6 , Meghan Morrow  1 , Julia Neckman  27 , Timothy Pearson  28 , Samuel R Peterson  29 , Christine Poblete-Lopez  30 , Chad L Prather  31 , Jennifer S Ranario  24 , Ashley G Rubin  32 , Chrysalyne D Schmults  19 , Andrew M Swanson  3 , Christopher Urban  33 , Y Gloria Xu  3 , Ross Pearlman  1 , Simon Yoo  1 , Vishnu Harikumar  1 , Alexandra Weil  1 , Matthew Schaeffer  1 , Sanjana Iyengar  1 , Emily Poon  1 , Brian A Cahn  34 , Murad Alam  35
Affiliations
Multicenter Study

How dermatologic surgeons decide to proceed with surgery for nonmelanoma skin cancer when site identification is initially uncertain: A nationwide, multicenter, prospective study

Areeba Ahmed et al. J Am Acad Dermatol. 2025 Jan.

Abstract

Background: Few studies show how dermatologic surgeons manage problems with site identification.

Objective: To estimate frequency and characterize management of skin cancer treated by surgery when the anatomic location of the tumor is in question.

Methods: Nationwide, prospective, multisite cohort study.

Results: Among 17,076 cases at 22 centers, 98 (0.60%) were lesions in question for which site identification was initially uncertain, with these more often in patients who were male, older, and biopsied more than 30 days ago. Surgeons employed on average 5.0 (95% CI: 4.61-5.39) additional techniques to confirm the site location, with common approaches including: re-checking available documentation (90 lesions, 92%); performing an expanded physical examination (89 lesions, 91%); and asking the patient to point using a mirror (61 lesions, 62%). In 15%, photographs were requested from the biopsying provider, and also in 15%, frozen section biopsies were obtained. In 10%, the referring physician was contacted. Eventually, surgeons succeeded in definitively identifying 82% (80 of 98) of initially uncertain sites, with the remaining 18% (18 of 98) postponed. Most postponed surgeries were at non-facial sites.

Limitations: Sites were academic centers.

Conclusions: When the anatomic location of the tumor is uncertain, dermatologic surgeons use multiple methods to identify the site, and sometimes cases are postponed.

Keywords: Mohs micrographic surgery; cutaneous surgery; dermbase; lesion in question; skin cancer; uncertain lesion location.

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Conflict of interest statement

Conflicts of interest Dr Bolotin reported serving as principal investigator on a clinical trial sponsored by Replimune outside the submitted work. Dr Cohen reported serving as a clinical investigator, consultant, or speaker or trainer for Accure, Allergan, Almirall/Athenex, Avuta, Biofrontera Bioscience, Biopelle, Brickell Biotech, Croma, Elta, Endo Pharmaceuticals, Ferndale, Galderma, InMode, IntraDerm, Lutronic, Merz, Novan, PCA, Pulse Biosciences, Raziel, Recros Medica, Revance, Revision, Sciton, and Sente outside the submitted work. Dr Council reported receiving personal fees from Sanofi-Genzyme Regeneron, AbbVie, and Castle Biosciences outside the submitted work. Dr Schmults reported serving as the National Comprehensive Cancer Network nonmelanoma panel chair, on the American Society for Dermatologic Surgery board of directors, and as International Society for Dermatologic and Esthetic Surgery secretary. Dr Xu serves as the National Comprehensive Cancer Network nonmelanoma panel member. Drs Ahmed, Campbell, Ibrahim, Kang, Aylward, Bari, Cherpelis, Condon, Farhang, Firoz, Garrett, Geronemus, Golda, Humphreys, Hurst, Jiang, Karia, Asadi, Kouba, MacFarlane, Maher, Miller, Moioli, Morrow, Neckman, Pearson, Peterson, Poblete-Lopez, Prather, Ranario, Rubin, Swanson, Urban, Xu, Pearlman, Yoo, Harikumar, Schaeffer, Iyengar, Poon, Cahn and Alam and authors Shi, Koza, Ma, Haq, Nadir, Yi, Dave, Hisham, Lin, Dirr, Bhatti, Helming, Jacobson, and Weil have no conflicts of interest to declare.

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