Dermatologic surgeryMohs micrographic surgery for melanoma: A prospective multicenter study
Section snippets
Patients
This study was initiated after Western Institutional Review Board review and approval (approval #20122132). The study consisted of 518 patients with 562 melanomas treated with MMS with MART-1 immunostaining prospectively recruited between April 8, 2013, and August 28, 2014. Inclusion criteria for our study were primary or recurrent melanoma confirmed by biopsy specimen, age 18 years or older, no clinical signs of regional or systemic disease, and treatment with MMS. All MMS procedures discussed
Patient and tumor characteristics
Demographics, clinical, and histopathologic characteristics of the 562 melanomas are outlined in Table II. When performing MMS, we consider “melanoma in situ”(MIS) and “lentigo maligna”(LM) the same for surgical margin purposes because they have been shown to be identical in prior studies.6, 9, 16 To avoid confusion, all in situ melanomas, regardless of histologic subtype, are referred to as NIM (noninvasive melanoma). Quantitatively, histologically characterized LM tumors (primary and
Discussion
Stronger evidence is needed to support surgical margins in the treatment of melanoma, particularly on the head, neck, hands, and feet. Current guidelines for excision margins are based on randomized controlled trials, but these trials only compared a wide margin against a wider margin, and in each trial, the more narrow margin was just as effective as the wider margin.10, 17, 18, 19, 20, 21, 22 Furthermore, these studies were limited to melanomas on the trunk and proximal extremities, leaving a
Conclusion
To our knowledge, this is the first-ever prospective multicenter study of MMS using frozen sections paired with MART-1 immunostaining for melanoma and represents an important step in refining and affirming information from previously published studies from single institutions on the utility of MMS for melanoma. Its prospective nature and numerous contributors from diverse facilities and geographic locations provides strong support for the value of immediate, complete margin evaluation with
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Outcomes of invasive melanoma of the head and neck treated with Mohs micrographic surgery – A multicenter study
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2022, Journal of Plastic, Reconstructive and Aesthetic SurgeryPatient-reported and clinical outcomes of skin graft-based digital Mohs reconstructions
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2022, Journal of the American Academy of DermatologyCitation Excerpt :Historically, aggressive HSs of BCC have included infiltrative, morpheaform, micronodular, and metatypical subtypes.4-6 Mohs micrographic surgery (MMS), with its precise and exhaustive margin examination, is especially well suited to methodically and precisely identify occult tumor extension.7-12 The purpose of this study was to correlate the HS of BCC with the likelihood of SCE as defined by the number of MMS stages required to clear the tumor.
Mohs Micrographic Surgery for the Treatment of Cutaneous Melanomas of the Head and Neck
2022, Oral and Maxillofacial Surgery Clinics of North AmericaCitation Excerpt :Notably, most melanomas included in these landmark trials were located on the trunk and proximal extremities, leading to a paucity of data for melanomas of the head and neck as well as other special sites.1 The advent of MMS, developed and pioneered by Dr Frederic E. Mohs, a general surgeon in the 1930s, revolutionized the definitive management of cutaneous malignancies.5–7 Unlike traditional WLE, which undergoes standard pathologic grossing and processing using “breadloaf,” also known as vertical sectioning and which allows for the histopathologic evaluation of less than 1% of the true surgical margin,6–9 the Mohs micrographic technique processed fresh-frozen tissue in a method that allowed for complete circumferential peripheral and deep margin assessment in real time, allowing for 100% true surgical margin assessment.5–7,9–12
Funding sources: 2012 American Society for Dermatologic Surgery Cutting Edge Research Grant ($5000).
Conflicts of interest: None disclosed.
The preliminary data were presented as a poster at the 2016 American College of Mohs Surgery on April 28, 2016 and as a brief presentation at the American Society for Dermatologic Surgery on November 6, 2014.