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).

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.