How to calculate Body Surface Area BSA (EN): BSA is the fundamental anthropometric indicator in oncology for chemotherapy dosing (mg/m^2), in cardiology for cardiac index (CO/BSA), in nephrology for normalized renal clearance (mL/min/1.73 m^2), in pediatrics for drug dosing, and in burn therapy for the Lund-Browder Rule of Nines. The calculator implements three classical formulas: Du Bois & Du Bois 1916 Columbia University New York historical gold standard, Mosteller 1987 NEJM letter simple formula most used today, Haycock 1978 Pediatrics formula for children.

Reference frameworks: FDA Food and Drug Administration, NCI National Cancer Institute Bethesda, NIH Bethesda, CDC Atlanta, ASCO American Society of Clinical Oncology Alexandria VA, NCCN National Comprehensive Cancer Network Plymouth Meeting PA, ASHP American Society of Health-System Pharmacists Bethesda, ASH American Society of Hematology Washington, ACS American Cancer Society Atlanta, AAP American Academy of Pediatrics, ABA American Burn Association Chicago, AHA American Heart Association Dallas, ACC American College of Cardiology, NKF National Kidney Foundation, KDIGO Kidney Disease Improving Global Outcomes; UK NHS, NICE, BNF British National Formulary, BSH British Society for Haematology, UKONS UK Oncology Nursing Society; European Society of Medical Oncology ESMO Lugano, SIOP Children's Oncology Group COG.

Cancer centers: MD Anderson Cancer Center Houston, Memorial Sloan Kettering New York, Dana-Farber Cancer Institute Boston, Mayo Clinic Cancer Center Rochester, City of Hope Duarte California, Fred Hutchinson Cancer Center Seattle, Sidney Kimmel Comprehensive Cancer Center Johns Hopkins, UCSF Helen Diller, UCLA Jonsson, Roswell Park Buffalo, Cleveland Clinic Taussig; pediatric St. Jude Children's Research Hospital Memphis, Boston Children's Hospital, Children's Hospital of Philadelphia CHOP, Texas Children's Houston, Cincinnati Children's; UK Royal Marsden London, Christie Manchester, Great Ormond Street Hospital London pediatric. Onco pharma: Roche Genentech, Pfizer New York, Novartis Cambridge MA, Bristol Myers Squibb Princeton, AstraZeneca Wilmington DE, Merck Rahway NJ, AbbVie Chicago, Janssen J&J, Bayer, Eli Lilly Indianapolis, Amgen Thousand Oaks CA, Gilead Sciences, Daiichi Sankyo, Takeda.

BSA Du Bois 1916 Mosteller 1987 Haycock 1978 formulas

Du Bois 1916 (historical gold standard): BSA = 0.007184 * W^0.425 * H^0.725 with W in kg and H in cm; valid 5-100 kg, derived from 9 adult subjects measured with paper molds. Mosteller 1987 (NEJM 317:1098 letter): BSA = sqrt(W * H / 3600) with W kg H cm; extreme mnemonic simplicity, today most used formula in clinical oncology and cardiology. Haycock 1978 (Pediatrics): BSA = 0.024265 * W^0.5378 * H^0.3964 calibrated on 81 pediatric subjects (neonates to adolescents) recommended by AAP and SIOP for pediatric oncology. Other notable formulas: Boyd 1935 (Du Bois refinement), Gehan-George 1970 NCI Bethesda chemotherapy specific (BSA = 0.0235*W^0.51456*H^0.42246), Costeff 1966, Schlich 2010, Yu 2003. Formulas yield similar results (within +-3-5%) for standard adults 1.5-2.2 m^2; diverge for small children and morbidly obese (BSA >2.5 m^2). BSA categories: <1.2 m^2 pediatric/very small, 1.2-1.59 below average, 1.6-1.89 average, 1.9-2.19 above average, ≥2.2 large. Average adult BSA ~1.73 m^2 (average woman ~1.6, average man ~1.9), used as standard for GFR normalization (eGFR mL/min/1.73 m^2 in CKD-EPI MDRD Cockcroft-Gault equations).

History BSA from Du Bois 1916 to Mosteller 1987

The first BSA formula was published in 1916 by brothers Eugene F. Du Bois and Delafield Du Bois Columbia University New York Presbyterian Hospital in A formula to estimate the approximate surface area if height and weight be known. Archives of Internal Medicine 17:863-871 1916. The formula was derived from direct measurements with paper molds on only 9 subjects, but remained the worldwide gold standard for over 50 years. Eugene Du Bois is celebrated as a pioneer of basal metabolism (calorimetry, BMR) and director of Russell Sage Institute of Pathology. Wallace Boyd 1935 University of Toronto refined Du Bois on a larger sample. In the 1970s came practical formulas: Edith Gehan and Susan George 1970 National Cancer Institute NCI Bethesda Estimation of human body surface area from height and weight. Cancer Chemotherapy Reports 54:225-235 1970 formulated BSA for standardized chemotherapy dosing (mg/m^2). George Haycock Guy's Hospital London 1978 in Geometric method for measuring body surface area: a height-weight formula validated in infants, children, and adults. Journal of Pediatrics 93:62-66 1978 developed the pediatric formula calibrated on 81 subjects including neonates and children. Robert D. Mosteller 1987 Simplified calculation of body-surface area.

New England Journal of Medicine 317:1098 1987 (one-sentence letter!) proposed sqrt(W*H/3600) which became immediately popular for mnemonic simplicity; today the most used formula in clinical oncology ASCO ESMO NCCN. BSA was born as a basal metabolism tool but became worldwide chemotherapy dosing standard from the 1960s (Pinkel 1958 Cancer Chemother Rep) and for cardiac index (Henderson 1928, Cournand 1941 Nobel Medicine 1956).

Typical BSA values and applications table

5 numerical BSA examples

Example 1 male 75 kg 175 cm Du Bois: BSA = 0.007184 * 75^0.425 * 175^0.725 = 0.007184 * 6.316 * 42.034 = 1.907 m^2 -> average. Mosteller: sqrt(75*175/3600) = 1.909 m^2 (excellent agreement within 0.002).

Example 2 female 60 kg 165 cm Mosteller: BSA = sqrt(60*165/3600) = 1.658 m^2 -> average; example chemotherapy dose paclitaxel 175 mg/m^2 = 290 mg per cycle; cisplatin 75 mg/m^2 = 124 mg; ASCO NCCN guidelines.

Example 3 child 20 kg 110 cm Haycock pediatric: BSA = 0.024265 * 20^0.5378 * 110^0.3964 = 0.784 m^2 -> pediatric; COG protocols methotrexate 1000 mg/m^2 = 784 mg; vincristine max dose 2 mg cap.

Example 4 morbidly obese 130 kg 180 cm Mosteller: BSA = sqrt(130*180/3600) = 2.550 m^2 -> large; some historical protocols capped BSA at 2.0-2.2 m^2; ASCO 2012 and 2019 guidelines recommend actual BSA non-capped for most agents (avoid undertreatment).

Example 5 newborn 3.5 kg 50 cm Haycock: BSA = 0.024265 * 3.5^0.5378 * 50^0.3964 = 0.223 m^2 -> pediatric/very small; NICU neonatal intensive care; St Jude COG pediatric oncology protocols; Boston Children's Cincinnati Children's Texas Children's CHOP.

BSA model limitations

BSA formulas are statistical estimates not direct measurements; error +-5-10% vs direct 3D scanner measurements. Du Bois Mosteller Haycock convergence within +-3-5% for standard adults; divergence up to 10% for morbidly obese (>2.5 m^2) or cachectic (<1.2 m^2). BSA capping in obese patients: historical practice limiting BSA to 2.0 m^2 to avoid chemo overdose; ASCO 2012 and 2019 updated guidelines recommend actual non-capped BSA for most drugs (except carboplatin dosed with Calvert AUC formula and bleomycin cumulative cap). Pediatrics: use Haycock 1978 (calibrated on 81 pediatric subjects) or Mosteller. Amputees: apply Bradley corrections subtracting limb-specific percentages. Cardiac index: CI = CO/BSA normal range 2.5-4.0 L/min/m^2; reduced in heart failure. eGFR mL/min/1.73 m^2: 1.73 normalization is standard adult BSA in CKD-EPI MDRD Cockcroft-Gault. Burns: Wallace 1951 Rule of Nines and Lund-Browder 1944 are based on BSA but use no numerical formulas. Carboplatin: NOT BSA-dosed but Calvert AUC formula with GFR (Calvert 1989).

Common BSA errors

Common pitfalls: using BSA for carboplatin dosing (error: use Calvert AUC GFR formula); applying Du Bois to children <5 kg (uncalibrated, use Haycock 1978); BSA capping at 2.0 m^2 in all obese (ASCO 2012-2019 recommend non-capped actual BSA); confusing BSA with BMI (BSA m^2 estimates surface, BMI kg/m^2 estimates mass); rounding weight or height (+-1 kg produces +-0.5% BSA); using Mosteller in very small infants (Haycock more accurate); forgetting kg/cm conversion (some US formulas use lb/in with different constants). Confusing BSA with: VBV Volume of Distribution Vd (pharmacokinetics); LBW Lean Body Weight; IBW Ideal Body Weight; ABW Adjusted Body Weight. Cardiac index: confusing CO Cardiac Output (L/min) with CI Cardiac Index (L/min/m^2). eGFR: 1.73 m^2 normalization may overestimate GFR in large BSA (>2.2) and underestimate in small (<1.5).

BSA applications USA UK NHS

1. Chemotherapy dosing: ASCO American Society Clinical Oncology Alexandria VA, NCCN National Comprehensive Cancer Network Plymouth Meeting PA, ASHP American Society Health System Pharmacists Bethesda; FDA drug labels Adriamycin Cisplatin Eloxatin Taxol; UK NHS NICE BNF dose; ESMO Lugano Switzerland.
2. NCI-designated cancer centers: MD Anderson Houston, Memorial Sloan Kettering NYC, Dana-Farber Boston, Mayo Clinic Rochester, City of Hope Duarte CA, Fred Hutchinson Seattle, Johns Hopkins Sidney Kimmel, UCSF Helen Diller, UCLA Jonsson, Roswell Park Buffalo, MD Anderson Cooper Camden NJ.
3. Pediatric oncology COG SIOP: St Jude Children's Research Hospital Memphis, Boston Children's, Children's Hospital of Philadelphia CHOP, Texas Children's Houston, Cincinnati Children's, Seattle Children's, Children's National DC; UK Great Ormond Street London; AIEOP Italy; SIOPE Europe Children's Oncology Group COG.
4. Cardiology AHA-ACC: cardiac index CI = CO/BSA range 2.5-4.0 L/min/m^2; echocardiography Doppler LVOT VTI; right heart catheterization Swan-Ganz; Cleveland Clinic Heart Vascular, Mayo Clinic Cardiovascular, Mass General Brigham Cardiac Center, NYU Langone Heart, Texas Heart Institute Houston, Stanford Heart.
5. Nephrology and burn centers: National Kidney Foundation NKF KDIGO eGFR mL/min/1.73 m^2 CKD-EPI MDRD Cockcroft-Gault; ABA American Burn Association Chicago Lund-Browder Rule of Nines; Shriners Burns Hospitals; UNC Burn Center; Brigham Burn Center; Baltimore Regional Burn Center.

Updated July 2026