The implantation of mohs micrographic surgery in Spain: a work still in progress.

Nearly 80 years have passed since Frederic Mohs began to develop the technique that now bears his name. During this period, the use of Mohs micrographic surgery (MMS) has spread and taken firm hold in some countries (especially the United States, where it originated), but has been more unevenly taken up in others, specifically in Europe. Few randomized clinical trials have compared treatment options in nonmelanoma skin cancer, in part because it is difficult to justify that research design to prove the efficacy of conventional surgery for high-risk tumors or to demonstrate the efficacy of MMS for low-risk tumors. For many authors, MMS has 2 main advantages over conventional surgery: a) lower recurrence rates for certain tumors, and b) smaller surgical defects. This second advantage, directly related to the aesthetic results of surgery, is sufficient to justify the use of MMS in the context of some health care systems. At first glance, MMS does not appear to be an economical technique (compared to conventional surgery) because it requires an investment in time, an infrastructure, and trained staff. In the context of private dermatology, of course, the expectation of superior aesthetic results may be reason enough for the physician and patient to agree on the suitability of MMS. In public health systems, however, the introduction of MMS may meet with several objections. First, health care administrators and dermatologists will argue that it makes no sense to divert resources indiscriminately into a costly type of surgery. It is therefore important to establish rigorous