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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

If one carefully reads the study by Essers et al¹ along with the trial published in the Lancet² on which it is based, it is apparent that the trial did not involve a randomization of patients to Mohs micrographic surgery (MMS) vs surgical excision. Therefore, conclusions about cost and therapeutic effectiveness may be misleading.

The form of MMS performed in the study by Essers et al used a 3-mm Mohs margin and resulted in a defect 4 mm larger than that obtained with a standard 1-mm Mohs margin. Whereas in standard MMS the surgeon performs pathologic analysis for a single fee, this study used a separate pathologist thereby increasing costs. Based on these 2 important methodological differences, the findings regarding tissue sparing, cost, and cosmesis may be inapplicable to MMS in the United States.

Additionally, patients did not undergo standard surgical excision. A standardized resection of 3 mm of margin . . . [Full Text of this Article]

AUTHOR INFORMATION
Clark C. Otley, MD

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