Note to our followers: Our nearly 13-year run of daily publication of new content on HealthNewsReview.org came to a close at the end of 2018. Publisher Gary Schwitzer and other contributors may post new articles periodically. But all of the 6,000+ articles we have published contain lessons to help you improve your critical thinking about health care interventions. And those will be still be alive on the site for a couple of years.
Read Original Story

Mohs surgery: Minimal scars vs. high cost

Mohs surgery: Minimal scars vs. high cost

Our Review Summary

The use of Mohs surgery has skyrocketed over the past few years – 248 percent from 1996 to 2008, according to Medicare data. The procedure is heralded as being the “preferred treatment” for certain types of skin cancer and boasts a cure rate of 98 to 99 percent. But Mohs is relatively expensive, costing about $200 more than excision, another standard therapy.

The story focuses on the financial aspects of Mohs and weighs that against the perceived benefits patients receive when choosing this therapy over other alternatives. But the article reads a bit like an advertisement for Mohs – touting its benefits without any mention of potential harms and limitations of the procedure. It also falls short on explaining whether Mohs is truly more expensive than standard excision, and why some groups are concerned about the surgery’s overuse.

 

Why This Matters

Skin cancer is becoming increasingly common with the global aging population and the thinning of the Earth’s ozone. In an era when policymakers talk about curbing spiraling health care costs, the average number of adults being treated for skin cancer is ever increasing, while treatment costs have more than doubled. An insightful piece shedding light on the economics of health care becomes even more important, especially when it can explain why certain, expensive treatments are (or should be) favored over other cheaper, proven therapies.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The main focus of the story is the higher cost of Mohs surgery, which is quoted to be around $1,100 per case, compared to about $900 for conventional excision. While that’s seemingly simple enough to understand, the issue gets confusing when the story quotes a doctor who calls Mohs a “bargain.” He says Mohs is actually less expensive because it involves a single payment to one doctor, whereas excision causes reimbursement to be spread out to the surgeon, pathologist, and lab. The story offers no evaluation of these contradictory claims. The piece also talks about Medicare and Medicaid cutting payments for Mohs and mentions a past proposal of limiting reimbursement to physicians. But it does not explicitly state whether most health insurance policies would cover the procedure for patients.

We’ll award a satisfactory rating since the story is primarily about costs. But we wish it had made clearer distinctions between the cost of performing the procedure, reimbursement, and patient charges.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The reporter makes clear the benefits of Mohs surgery in exchange for its high costs. The article states the procedure spares more tissue and produces better cosmetic results than conventional excision while boasting a cure rate of 98 to 99 percent, according to unidentified studies. The article also does a good job explaining when Mohs would be an appropriate intervention. Mohs is optimal, the article says, when the non-melanomas cover cosmetically important areas.

While we would have liked to have seen some seen some data supporting the statement about the cosmetic benefits of Mohs, we’ll call the overall discussion here good enough for a satisfactory.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story cautions that Mohs is not a one-stop fix, as it relates a story of a patient who needed additional help from a plastic surgeon for her multi-step reconstruction.

But no discussion of harms is included in the story, nor are the risks of potential complications, such as nerve damage, bleeding and infection. The piece only mentions the benefits of Mohs, with no mention of disadvantages and limitations of the surgery compared to other traditional therapies.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

Mohs surgery logs an impressive cure rate of 98 to 99 percent, according to unnamed studies in the article. But these figures could have been more accurately described and attributed in the article.

The following questions come to mind:

  • How was the cure rate measured?
  • For how long?
  • According to whom?
  • Is this the cure rate for all skin cancers? Or the cure rate for only a certain type?

(Note:  In our original review, the following statement appeared, but has now been left in place with a strikethrough because one of our readers challenged the accuracy of the statement that “Moh’s surgery is actually standard for treatment of melanoma.”)

In addition, the article could have done a better job of explaining that Moh’s surgery is actually standard for treatment of melanoma, a less common but more deadly form of skin cancer compared with the carcinomas described in the story. Until recently, Moh’s surgery has not been customary for these less common nonmelanoma skin cancers.

Does the story commit disease-mongering?

Satisfactory

The story does not engage in disease mongering. It explained the “epidemic” of skin cancer with reliable data from the US Centers for Disease Control and Prevention.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story quotes a Fox Chase Cancer Center dermatologist and two of his patients regarding their experience with Mohs. We also hear from two other physicians who are experts in the procedure. One talked about how Mohs is “misperceived” as expensive. The other talked about the controversy of the surgery’s categorization in the medical field.

We’ll award a satisfactory here to recognize the breadth of perspectives offered, but with the following caveat: All of the expert sources appear to have some investment in the procedure and may be biased to view it favorably. It would have been interesting to hear from a totally objective source about why Mohs is more expensive than other therapies, or why the surgery seems to be overused by dermatologists.

Does the story compare the new approach with existing alternatives?

Satisfactory

The article talks about typical therapies for non-melanomas in a doctor’s office, including topical drugs, freezing or lasering.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story establishes Mohs as the “preferred treatment for the most common types of skin cancer” and adds that its use has skyrocketed to 248 percent from 1996 to 2008. The story also discusses a proposal to limit who can perform the surgery, which theoretically might decrease availability of the procedure.

Does the story establish the true novelty of the approach?

Satisfactory

The article touches upon the procedure’s history, stating that Wisconsin surgeon Frederic E. Mohs developed the process in the 1940s. It makes clear that Mohs is not a novel approach.

Does the story appear to rely solely or largely on a news release?

Satisfactory

We couldn’t find a similar press release online for this story. Furthermore, the article quotes two independent dermatologists from the American College of Mohs Surgery and from the American Academy of Dermatology. We can be sure from this original reporting that the story isn’t based on a press release.

Total Score: 8 of 10 Satisfactory

Comments (2)

Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.

George Maxted

February 6, 2015 at 10:00 am

Gives short shrift to cryotherapy – destruction of the lesion by freezing. We treat cervical cancer that way, why not skin cancer?

Reply

Cecilia Eichenberger

October 7, 2018 at 5:12 pm

But I suspect this article doesn’t consider the plastic surgeon brought in to patch up the hole created by digging out the bad cells. $200 difference from doctor’s method in office is not major, but Medicare surely doesn’t cover the plastic surgeon. That’s what I want to know. Thanks for an answer.

Reply