Giving surgeons feedback on how their performance compares with norms is effective in reducing overuse of Mohs micrographic surgery, a study suggests.

US researchers designed an audit-and-feedback intervention aimed at reducing extreme overuse of Mohs surgery by confidentially sharing stages-per-case performance data with individual surgeons benchmarked to their peers nationally for similar head and neck lesions.

In Mohs surgery, skin cancers such as basal or squamous cell carcinomas are removed in resection layers, known as stages.

There has been concern that some surgeons were using too many stages — perhaps partly because of a “perverse incentive” fee-for-service in the US whereby surgeons earn more by doing more stages, the authors write in JAMA Dermatology.