Journal Information
Vol. 106. Issue 9.
Pages 764-766 (November 2015)
Vol. 106. Issue 9.
Pages 764-766 (November 2015)
Case and Research Letters
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Census of Centers That Perform Mohs’ Micrographic Surgery in Spain and Description of Their Activity: A Feasibility Study for the Mohs’ Micrographic Surgery Registry of the Foundation of the Spanish Academy of Dermatology and Venereology
Censo de los centros que realizan cirugía de Mohs en España y descripción de su actividad: estudio de factibilidad para el registro de cirugía de Mohs de la FAEDV
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T. Alonso-Alonsoa,
Corresponding author
taabarroso@gmail.com

Corresponding author.
, P. Redondo-Bellonb, O. Sanmartín-Jiménezc, E. de Eusebio-Murillod, I. García-Dovale, M.Á. Rodríguez-Prietoa
a Dermatología, Hospital Universitario de León, León, Spain
b Dermatología, Clínica Universitaria de Navarra, Pamplona, Navarra, Spain
c Dermatología, Instituto Valenciano de Oncología, Valencia, Spain
d Dermatología, Hospital Universitario de Guadalajara, Guadalajara, Spain
e Dermatología, Fundación Academia Española de Dermatología y Venereología, Madrid, Spain
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Tables (1)
Table 1. Centers That Performed Mohs Micrographic Surgery in January 2013 and Were Thus Included in the Survey.
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To the Editor:

Since the forties, when Mohs micrographic surgery was first described,1 the technique has become widely employed in countries such as the United States and Australia.2–6 Implantation in Spain7–10 and other European countries came later and has been less uniform. There are several techniques that can be used to perform Mohs micrographic surgery, each requiring different resources and possibly affecting the final outcome. In 2013, the Foundation of the Spanish Academy of Dermatology and Venereology (FAEDV), in association with the Dermatologic Surgery, Laser, and Cutaneous Oncology working group of the AEDV, proposed the launch of a National Mohs Micrographic Surgery Register, the main objectives of which would be to describe the outcomes of Mohs micrographic surgery under conditions of daily practice, to determine the prognostic factors affecting the outcome of Mohs micrographic surgery for skin cancer, and to analyze the possible influence of technical factors on outcomes. Other objectives were to determine whether the indications for the technique were homogeneous in the different centers in terms of tumor and patient characteristics, and the reasons for not using the technique.

A first step towards these objectives was to perform a survey of centers that regularly performed Mohs micrographic surgery and to quantify their activity in order to estimate the viability and statistical power of the register.

We have therefore performed a survey of the centers that perform Mohs micrographic surgery in Spain. Three sources were used: a survey performed in the Surgery Group of the AEDV during the 2012 meeting, and repeated by e-mail in January 2013; a survey sent to all members of the AEDV via the website and returned by Info AEDV in December 2012 and January 2013; and, finally, a key person in Mohs micrographic surgery was contacted in each autonomous community to perform an external review of participating centers, with the aim of identifying those centers that regularly performed Mohs micrographic surgery but had not replied to the survey and inviting them to participate in the register.

In this way we obtained data from 30 centers. Of these, 23 replied to the survey that described their activity (Table 1).

Table 1.

Centers That Performed Mohs Micrographic Surgery in January 2013 and Were Thus Included in the Survey.

Autonomous Community  City  Center 
Andalusia     
  Malaga  Hospital Virgen de la Victoria 
  Seville  Hospital Virgen del Rocío 
  Seville  Hospital Virgen Macarena 
Castile and Leon     
  Leon  Hospital General Universitario de León 
Castile-La Mancha     
  Guadalajara  Hospital Universitario de Guadalajara 
Catalonia     
  Barcelona  Hospital Clínic 
  Barcelona  Hospital del Mar 
  Barcelona  Hospital de la Santa Creu i Sant Pau 
  Barcelona  Hospital Universitario Sagrado Corazón 
  Barcelona  Centro Médico Teknon 
  Barcelona  Clínica Dexeus Iderma 
  Barcelona  Instituto Pablo Umbert. Clínica Corachan 
Madrid Community     
  Madrid  Hospital Clínico San Carlos 
  Madrid  Hospital de Alcorcón 
  Madrid  Hospital de la Princesa 
  Madrid  Hospital Gregorio Marañón 
  MadridMadrid  Hospital Ramón y CajalHospital Virgen de la Paloma 
  Madrid  Hospital La Zarzuela 
  Madrid  Hospital Moncloa 
  Madrid  Hospital Quirón Madrid 
Valencian Community     
  Valencia  Hospital de Manises 
  Valencia  Instituto Valenciano de Oncología 
Basque Country     
  Barakaldo  Hospital Universitario de Cruces 
  San Sebastian  Policlínica Gipuzkoa 
Balearic Islands     
  Manacor  Hospital Son Llàtzer 
  Palma  Hospital Quirón Palmaplanas 
Canary Islands     
  Las Palmas Gran Canaria  Complejo Hospitalario Universitario Insular Materno-Infantil 
  Las Palmas Gran Canaria  Consulta Dr. Jiménez Acosta 
Navarra     
  Pamplona  Clínica Universidad de Navarra 

Overall, these 23 centers performed 160 operations a month, and it was always a dermatologist who performed the Mohs micrographic surgery. In 22 centers (96%), Mohs micrographic surgery was performed using a fresh-tissue technique and in 15 (65%) using a fixed-tissue technique. Interpretation of the histological sections was done by a pathologist in 21 centers (91%), by a dermatologist in 2 (9%), and by both in 2 (9%). With regard to closure of the defect left by the surgery, this was performed by the dermatologist in all the centers, though often with the collaboration of plastic surgeons in 4 of them (17%) and with other specialists in one (4%).

The main finding of this survey was that the availability of Mohs micrographic surgery does not present a homogeneous geographic distribution in our country.

The limitations of our study include the absence of a detailed description of all the centers that perform Mohs micrographic surgery because the centers did not receive or reply to the questionnaires, as can occur in all surveys, or the experts consulted did not identify all the centers. There may also have been bias in the declaration of the activity. Furthermore, the results are not static but may vary over time. Finally, the concept of Mohs micrographic surgery includes various techniques with different degrees of complexity and this variable complexity may not be adequately reflected in our results.

Based on the data from this study, we consider it possible to draw up a register of Mohs micrographic surgery, and the sample size and the statistical power have been established. In addition, we will be able to determine to what degree the results of the register are representative of Mohs micrographic surgery in Spain. The results may also be useful to plan health care and evaluate the geographic distribution of this type of service, and to facilitate appropriate patient referral and dermatologist training.

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Please cite this article as: Alonso-Alonso T, Redondo-Bellon P, Sanmartín-Jiménez O, de Eusebio-Murillo E, García-Doval I, Rodríguez-Prieto MÁ. Censo de los centros que realizan cirugía de Mohs en España y descripción de su actividad: estudio de factibilidad para el registro de cirugía de Mohs de la FAEDV. Actas Dermosifiliogr. 2015;106:764–766.

Copyright © 2014. Elsevier España, S.L.U. and AEDV
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