In contrast to previous survey-based studies estimating IHC utilization rates amongst Mohs surgeons ranging from 12- 21.7%,1,2 our study notes a more modest rate between 4.6% (2012) and 6.3% (2017). Despite there being a significant increase in the number of Mohs surgeons utilizing IHC, and the increase in the number of IHC services approaching significance, the low absolute values of both of these variables suggests that only a minority of Mohs surgeons, 75% of whom are fellowship trained, are utilizing IHC and even within this minority, the utilization of IHC is not frequent, as 90% of those who use IHC, use it in less than 21% of MMS cases.
In Trimble and Cherpeli’s 2013 survey,2 a subset of Mohs surgeons indicated that the most common reasons for not using IHC were time consumption, costs, and lack of education. In recent years, limiting factors such as time and reliability have been improved by rapid protocols, and cost has been decreased with cost-effective reagents.3 As IHC in MMS expands to the treatment of additional tumors, it may be an increasingly important technique, particularly in the setting of melanoma and melanoma in-situ with increasing rates of these tumors over the past decade.4 While our data notes a slow but steady increase in the number of Mohs surgeons utilizing IHC, in the future, the development of a curriculum in interpreting IHC stains may be of particular benefit to overcome education as a limiting factor in IHC utilization and can additionally serve as a resource when IHC stains are tested on the Mohs certification examination. As 75% of Mohs surgeons who utilize IHC in our study are fellowship-trained, dedicated education during fellowship may represent an important factor for growth in the utilization of IHC.
In Trimble and Cherpeli’s 2013 survey,2 a subset of Mohs surgeons indicated that the most common reasons for not using IHC were time consumption, costs, and lack of education. In recent years, limiting factors such as time and reliability have been improved by rapid protocols, and cost has been decreased with cost-effective reagents.3 As IHC in MMS expands to the treatment of additional tumors, it may be an increasingly important technique, particularly in the setting of melanoma and melanoma in-situ with increasing rates of these tumors over the past decade.4 While our data notes a slow but steady increase in the number of Mohs surgeons utilizing IHC, in the future, the development of a curriculum in interpreting IHC stains may be of particular benefit to overcome education as a limiting factor in IHC utilization and can additionally serve as a resource when IHC stains are tested on the Mohs certification examination. As 75% of Mohs surgeons who utilize IHC in our study are fellowship-trained, dedicated education during fellowship may represent an important factor for growth in the utilization of IHC.
DISCLOSURES
The authors have no conflicts.
REFERENCES
1. Robinson JK. Current histologic preparation methods for Mohs micrographic surgery. Dermatol Surg. 2001;27(6):555-560.
2. Trimble JS, Cherpelis BS. Rapid immunostaining in Mohs: current applications and attitudes. Dermatol Surg. 2013;39(1 Pt 1):56-63.
3. Cohen DK, Goldberg DJ. Mohs Micrographic Surgery: Past, Present, and Future. Dermatol Surg. 2019;45(3):329-339.
4. Foundation TSC. Skin Cancer Facts & Statistics. The Skin Cancer Foundation. https://www.skincancer.org/skin-cancer-information/skin-cancer-facts/. Published 2020. Accessed May 20, 2020.
2. Trimble JS, Cherpelis BS. Rapid immunostaining in Mohs: current applications and attitudes. Dermatol Surg. 2013;39(1 Pt 1):56-63.
3. Cohen DK, Goldberg DJ. Mohs Micrographic Surgery: Past, Present, and Future. Dermatol Surg. 2019;45(3):329-339.
4. Foundation TSC. Skin Cancer Facts & Statistics. The Skin Cancer Foundation. https://www.skincancer.org/skin-cancer-information/skin-cancer-facts/. Published 2020. Accessed May 20, 2020.
AUTHOR CORRESPONDENCE
Parth Patel MD parpatel@montefiore.org
