Mohs Micrographic Surgery for the Treatment of Melanoma

Hui, Andrea; Jacobson, Michael A.; Markowitz, Orit; Brooks, Norman A.; Siegel, Daniel M.

doi:10.1016/j.det.2012.04.010

Cited by 19 publications

(39 citation statements)

References 88 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the rise of immunostains, in particular melanoma antigen recognized by T cells (MART-1), has made the histopathological interpretation of melanoma more feasible. 4,[27][28][29][30] Recently, several single-institution studies 12-14 have reported excellent outcomes with invasive melanoma treated with MMS and MART-1 immunostaining, with local recurrence rates ranging from 0 to 1.43%.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Survival After Mohs Micrographic Surgery vs Wide Margin Excision for Early-Stage Invasive Melanoma

et al. 2019

View full text Add to dashboard Cite

IMPORTANCE Melanoma is among the most common malignant neoplasms in the United States, with 91 270 cases estimated to be diagnosed in 2018. Since 2012, Mohs micrographic surgery (MMS) has gained popularity in the treatment of melanoma in situ. Although current guidelines for invasive melanoma without nodal metastases recommend surgery with wide margin excision (WME), use of MMS for this disease has increased as well, particularly in early stages. How the survival outcomes after each procedure compare with one another for early-stage invasive melanoma is unknown to date. OBJECTIVE To evaluate overall survival of patients with stage I melanoma defined by the American Joint Committee on Cancer Cancer Staging Manual, 8th edition (AJCC-8) after MMS vs traditional WME. DESIGN, SETTING, AND ANALYSIS This retrospective cohort study includes all patients with AJCC-8 stage I melanoma who underwent MMS or WME in the National Cancer Database with a diagnosis from January 1, 2004, through December 31, 2014. The National Cancer Database includes all reportable cases from Commission on Cancer-accredited facilities and represents approximately 50% of all newly diagnosed melanoma cases in the United States. Data were analyzed from November 13, 2018, through June 9, 2019. EXPOSURES MMS vs WME. MAIN OUTCOMES AND MEASURES Overall survival evaluated using multivariable Cox proportional hazards regression analysis. RESULTS A total of 70 319 eligible patients (52.3% male and 47.7% female; median [SD] age, 57.0 [16.2] years) were identified, including 67 085 treated with WME and 3234 treated with MMS. Multivariable Cox proportional hazards regression survival analysis controlling for clinical and tumor factors revealed that treatment with MMS was associated with a modest improvement in overall survival relative to WME (hazard ratio [HR], 0.86; 95% CI, 0.76-0.97). Propensity score-matched analysis of cohorts of patients treated with MMS vs WME also found modestly improved survival for those treated with MMS (HR, 0.82; 95% CI, 0.68-0.98). Academic facilities were more likely to use MMS than nonacademic facilities (odds ratio, 2.03; 95% CI, 1.88-2.18). CONCLUSIONS AND RELEVANCE These findings suggest that Mohs surgery may provide an alternative approach to traditional WME for appropriately selected cases of AJCC-8 stage I melanoma without compromising patient survival.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparison of Survival After Mohs Micrographic Surgery vs Wide Margin Excision for Early-Stage Invasive Melanoma

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The study revealed that when comparing each thickness group, 5-year survival and metastasis rates were equal or better in the MMS treated patients than the 15,798 historical control patients who underwent wide margin excision. Other such studies by Zitelli and colleagues that included more than 1000 cases over 15 and 22-year-periods have been extensively reviewed in several studies, including recent review papers by Whalen et al [ 13 ] and Hui et al [ 15 ] The Zitelli studies found a local recurrence rate of 0.5% for MIS when treated with MMS compared to 6% for MIS treated with standard surgery [ 17 ].…”

Section: Surgical Margins For Melanoma In-situ mentioning

confidence: 99%

Update and Review on the Surgical Management of Primary Cutaneous Melanoma

et al. 2014

View full text Add to dashboard Cite

The surgical management of malignant melanoma historically called for wide excision of skin and subcutaneous tissue for any given lesion, but has evolved to be rationally-based on pathological staging. Breslow and Clark independently described level and thickness as determinant in prognosis and margin of excision. The American Joint Committee of Cancer (AJCC) in 1988 combined features from each of these histologic classifications, generating a new system, which is continuously updated and improved. The National Comprehensive Cancer Network (NCCN) has also combined several large randomized prospective trials to generate current guidelines for melanoma excision as well. In this article, we reviewed: (1) Breslow and Clark classifications, AJCC and NCCN guidelines, the World Health Organization’s 1988 study, and the Intergroup Melanoma Surgical Trial; (2) Experimental use of Mohs surgery for in situ melanoma; and (3) Surgical margins and utility and indications for sentinel lymph node biopsy (SLNB) and lymphadenectomy. Current guidelines for the surgical management of a primary melanoma of the skin is based on Breslow microstaging and call for cutaneous margins of resection of 0.5 cm for MIS, 1.0 cm for melanomas ≤1.0 mm thick, 1–2 cm for melanoma thickness of 1.01–2 mm, 2 cm margins for melanoma thickness of 2.01–4 mm, and 2 cm margins for melanomas >4 mm thick. Although the role of SLNB, CLND, and TLND continue to be studied, current recommendations include SLNB for Stage IB (includes T1b lesions ≤1.0 with the adverse features of ulceration or ≥1 mitoses/mm2) and Stage II melanomas. CLND is recommended when sentinel nodes contain metastatic deposits.

show abstract

“…With the bread‐loafing technique of WLE, less than 1% of the surgical margin is analyzed, and for this reason WLE has been associated with considerable recurrence rates. Alternative surgical techniques have been proposed including Mohs micrographic surgery (MMS) . MMS is a technique which allows tissue sparing whilst examining close to 100% of the margin.…”

Section: Introductionmentioning

confidence: 99%

“…Alternative surgical techniques have been proposed including Mohs micrographic surgery (MMS). 6,7 MMS is a technique which allows tissue sparing whilst examining close to 100% of the margin. MMS is also a more time-efficient procedure where the tumor-free margins can be confirmed on the same day prior to reconstruction, in comparison to WLE, which is often a staged procedure.…”

Section: Introductionmentioning

confidence: 99%

Mohs micrographic surgery versus wide local excision for melanoma in situ: analysis of a nationwide database

Phan

Loya

2019

Int J Dermatology

View full text Add to dashboard Cite

Background With the rising incidence of melanoma in situ (MIS) or cutaneous melanoma, there is an increasing emphasis on the need to understand optimal treatment strategies. The current standard of surgical care is wide local excision (WLE). Alternative surgical techniques have been proposed including Mohs micrographic surgery (MMS). We aimed to compare survival rates following WLE versus MMS surgery for MIS. Methods We performed a retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) cancer registry. 24,515 cases of WLE were identified and compared with 4122 cases of MMS surgery for MIS. Results There was a significantly higher proportion of elderly patients aged ≥75 years in the MMS group compared to WLE (23.3% vs. 15.3%). The proportion of females was higher for WLE compared to MMS (48.8% vs. 40%). Facial MIS tumors were significantly higher for MMS, as were scalp/neck tumors. After adjustment for confounding factors, there was no significant difference in cancer‐specific survival (HR 0.928, 95% CI 0.596–1.446, P = 0.74) and overall survival (HR 1.006, 95% CI 0.896–1.129, P = 0.924). Conclusion Adjusted analyses demonstrated no differences in overall survival or cancer‐specific survival between MIS patients treated with MMS compared with WLE.

show abstract

Mohs Micrographic Surgery for the Treatment of Melanoma

Cited by 19 publications

References 88 publications

Comparison of Survival After Mohs Micrographic Surgery vs Wide Margin Excision for Early-Stage Invasive Melanoma

Comparison of Survival After Mohs Micrographic Surgery vs Wide Margin Excision for Early-Stage Invasive Melanoma

Update and Review on the Surgical Management of Primary Cutaneous Melanoma

Mohs micrographic surgery versus wide local excision for melanoma in situ: analysis of a nationwide database

Contact Info

Product

Resources

About