Increasing Mohs Micrographic Surgery Utilization in Darker Skin Phenotypes From 2011 to 2022

BACKGROUND: Skin cancer incidence continues to rise, yet national treatment trends among lighter- and darker-skinned patient populations have not been compared. OBJECTIVE: To evaluate procedural skin cancer treatments trends. MATERIALS AND METHODS: The authors used Optum's deidentified Clinformatics Data Mart Database (2011-2022) to identify patients with light skin (race value: White; Skin Color Ethnicity [SCE] I‒III) and those with darker skin (race values: African, Asian, Hispanic; SCE IVa-VI). The authors identified skin cancer treatments using Current Procedural Treatment codes for Mohs Micrographic Surgery (MMS), wide local excision (WLE), and destructive skin cancer treatments with same-day International Classification of Disease 9/10 codes for basal cell carcinoma, squamous cell carcinoma, melanoma, and Merkel cell carcinoma. Mann-Kendall tests and Joinpoint analysis assessed trends over time and evaluated average annual percent changes (AAPCs). RESULTS: The authors included 1,625,367 adult patients with 4,184,496 skin cancer treatments. Annual MMS frequency increased from 2011 to 2022 for both groups {SCE IVa‒VI 53.9% increase, AAPC 3.89% (95% confidence interval [CI] 2.84-4.96, p < .001); SCE I‒III 46.7% increase, AAPC 3.86% (95% CI 3.61-4.12, p < .001)}. The rates for WLE and destructive methods decreased for both populations ( p < .001). CONCLUSION: Mohs micrographic surgery utilization is increasing over time for both lighter- and darker-skinned patients.