Dermatology & Plastic Surgery Institute Outcomes

Mohs micrographic surgery provides superior cure rates and tissue sparing in high-risk skin cancers frequently arising in functionally and cosmetically crucial sites. It is most commonly used to treat basal cell and squamous cell carcinomas, as well as other tumors associated with high recurrence rates after wide local excision.

In 2019, the Department of Dermatology’s 6 full-time fellowship-trained Mohs surgeons treated 4966 skin cancer cases at 4 Cleveland Clinic Mohs surgery locations, all of which are certified by the Clinical Laboratory Improvement Amendments. The Mohs surgeons performed 94% of the wound reconstructions for these patients, including primary complex closures (52%), primary intermediate closures (17%), flaps (11%), and grafts (3%). Eighteen percent of wounds were left to heal by secondary intention.

The Center for Medicare & Medicaid Services reported a national mean of 1.7 Mohs stages required to obtain tumor-free margins from 2012 to 2014¹ and 1.7 stages in 2017.² Cleveland Clinic Mohs surgeons performed within 1 standard deviation of this mean, requiring an average of 1.6 stages per case to achieve a tumor-free plane in 2017, 1.4 stages in 2018, and 1.4 stages in 2019. The national mean for stages required to clear high-risk skin cancers located on the trunk and extremities was 1.4; all surgeons performed within 1 standard deviation of this metric. The mean national percentage of trunk and extremity Mohs surgery cases was 16% in 2017; at Cleveland Clinic, the range for this metric was 0-16%. Since formally tracking adherence to Appropriate Use Criteria for Mohs micrographic surgery in 2018 all surgeons have performed at 100%.