LAUSR

practice for sebaceous carcinoma. 2,3 These results suggest that a large proportion of porocarcinoma and MAC are managed with MMS despite the limited evidence. This information chal-lenges recent studies describing MMS as an infrequently used modality for porocarcinoma. 4 Curiously, Western and rural cases were more likely to use MMS for AC. This finding may be because of a difference in referral patterns. Of note, MMS use rates for AC did not differ significantly based on race or insurance status. Uninsured patients, in comparison to Medicare patients, approached but did not reach a significantly higher risk of death in our Cox model. Additionally, tumor size was not a significant predictor of overall survival. Limitations to our study include the absence of recurrence data and small sample sizes in a subset analysis, precluding effective subgroup analysis for specific AC histologies. Other limitations include the CoC facil-ity-based nature of NCDB data. As a reference, about 52% of melanoma cases in the United States were captured by NCDB from 2012 – 2014, 5 suggesting that a significant portion of United States AC was not accounted for in this study. The utilization of MMS differs significantly based on AC histology, geographic region, and patient characteristics. MMS demonstrated similar overall survival for AC compared to WLE, and it appears to be a commonly used approach for porocarcinoma and MAC in particular.