Cost and cost-effectiveness of Mohs micrographic surgery versus conventional excision for nonmelanoma skin cancer: A scoping review.

BACKGROUND

Nonmelanoma skin cancers (NMSCs) are commonly treated with conventional excision (CE) or Mohs micrographic surgery (MMS), but their relative cost-effectiveness remains uncertain.

OBJECTIVE

To summarize the available economic evidence comparing MMS and CE for NMSC and, secondarily, to identify methodological gaps that limit interpretation of comparative cost-effectiveness.

METHODS

We performed a scoping review of EMBASE, Scopus, PubMed, and Cochrane (January 11, 2025). Studies reporting costs and/or incremental cost-effectiveness between MMS and CE for NMSC were included.

RESULTS

Twelve studies (1999-2023) from the United States (n = 9), the Netherlands (n = 2), Australia (n = 1), and Iran (n = 1) were eligible. Reported costs ranged from $408-$3534 for MMS and $587-$2644 for CE, with directionality driven by repair complexity and care setting.

LIMITATIONS: Main limitations included cross-system cost incomparability, predominance of observational designs with short horizons, inconsistent capture of downstream recurrence costs and patient-reported outcomes, and reliance on appropriate use criteria not designed for economic inference.

CONCLUSION

Despite superior clinical margin control with MMS, inconsistent economic methods yield conflicting cost-effectiveness conclusions. Standardized, data-driven evaluations that incorporate comprehensive costs, long-term outcomes, and patient-centered measures are needed to guide the indication-specific use of MMS versus CE.