Validation of the Webb and Rivera Score in Predicting Complexity of Mohs Surgery Procedures: A Retrospective Study

Background: Mohs micrographic surgeries (MMSs) vary in complexity and corresponding procedural duration. Preoperative triage of MMS cases enables physicians to estimate procedure duration and create an efficient schedule. The Webb and Rivera (WAR) score is a quantitative formula developed to predict complexity in Mohs cases based on tumor diameter, history of recurrence, location, and aggressiveness. Patients are given a score between 0 and 5 based on this information, with increasing surgical complexity for higher scores. Purpose: We aim to assess the association between WAR score, the number of stages, and repair type used in MMS to determine its value for clinical practice. Methods: Data for WAR score calculation were collected and analyzed for patients with squamous cell carcinoma and/or basal cell carcinoma treated with MMS between 2019 and 2023. Analyses were performed to determine if there was significant heterogeneity across WAR score groups. The Mantel–Haenszel Chi-square tests were performed for ordered categorical variables (Mohs stage), and Chi-square tests were performed for nonordered categorical variables. The results were verified using Fisher’s exact test when more than 25% of cells had an expected count of