Mohs Micrographic Surgery for the Treatment of External Ear Melanoma: an Outcome Study

Puyana, Carolina; Ham, Paula J.; Tsoukas, Maria M.

doi:10.1097/dss.0000000000002229

Cited by 4 publications

(5 citation statements)

References 25 publications

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“…At times, a particular location might lead to a consideration of Mohs surgery rather than traditional WLE to minimize skin loss. Examples include the eyelid [ 35 ], ear [ 36 ], lips [ 37 ], face [ 38 ], hands and feet [ 39 ]. In Australia, it has been concerning that many melanoma patients’ tumors are not excised with the required margins of clearance.…”

Section: Excision Marginsmentioning

confidence: 99%

Primary Cutaneous Melanoma—Management in 2024

Dixon,

Sladden,

Zouboulis

et al. 2024

JCM

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Background: Maximizing survival for patients with primary cutaneous melanomas (melanomas) depends on an early diagnosis and appropriate management. Several new drugs have been shown to improve survival in high-risk melanoma patients. Despite well-documented guidelines, many patients do not receive optimal management, particularly when considering patient age. Objective: to provide an update on melanoma management from the time of the decision to biopsy a suspicious skin lesion. Methods: We reviewed melanoma-management research published between 2018 and 2023 and identified where such findings impact and update the management of confirmed melanomas. Pubmed, Google Scholar, Ovid and Cochrane Library were used as search tools. Results: We identified 81 publications since 2017 that have changed melanoma management; 11 in 2018, 12 in 2019, 10 in 2020, 12 in 2021, 17 in 2022 and 18 in 2023. Discussion: Delayed or inaccurate diagnosis is more likely to occur when a partial shave or punch biopsy is used to obtain the histopathology. Wherever feasible, a local excision with a narrow margin should be the biopsy method of choice for a suspected melanoma. The Breslow thickness of the melanoma remains the single most important predictor of outcome, followed by patient age and then ulceration. The BAUSSS biomarker, (Breslow thickness, Age, Ulceration, Subtype, Sex and Site) provides a more accurate method of determining mortality risk than older currently employed approaches, including sentinel lymph node biopsy. Patients with metastatic melanomas and/or nodal disease should be considered for adjuvant drug therapy (ADT). Further, high-risk melanoma patients are increasingly considered for ADT, even without disease spread. Invasive melanomas less than 1 mm thick are usually managed with a radial excision margin of 10 mms of normal skin. If the thickness is 1 to 2 mm, select a radial margin of 10 to 20 mm. When the Breslow thickness is over 2 mm, a 20 mm clinical margin is usually undertaken. In situ melanomas are usually managed with a 5 to 10 mm margin or Mohs margin control surgery. Such wide excisions around a given melanoma is the only surgery that can be regarded as therapeutic and required. Patients who have had one melanoma are at increased risk of another melanoma. Ideal ongoing management includes regular lifelong skin checks. Total body photography should be considered if the patient has many naevi, especially when atypical/dysplastic naevi are identified. Targeted approaches to improve occupational or lifestyle exposure to ultraviolet light are important. Management also needs to include the consideration of vitamin D supplementary therapy.

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Section: Excision Marginsmentioning

confidence: 99%

Primary Cutaneous Melanoma—Management in 2024

Dixon,

Sladden,

Zouboulis

et al. 2024

JCM

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“…demonstrated lower local recurrence rates for cutaneous head and neck melanoma after treatment with MMS (0.61%; 95% CI 0.1%–1.4%) vs. staged excision (1.8%; 95% CI 1.0%–2.9%) and WLE (7.8%; 95% CI 6.4%–9.3%). A study investigating excision of 8212 external ear melanomas 18 showed that survival after MMS was at least equivalent to that of WLE, but with the benefit of normal tissue preservation. Additionally, Terushkin et al 12 .…”

Section: Mohs Micrographic Surgery For Different Types Of Skin Cancermentioning

confidence: 99%

“…14 The meta-analysis published by Bittar et al 6 demonstrated lower local recurrence rates for cutaneous head and neck melanoma after treatment with MMS (0.61%; 95% CI 0.1%-1.4%) vs. staged excision (1.8%; 95% CI 1.0%-2.9%) and WLE (7.8%; 95% CI 6.4%-9.3%). A study investigating excision of 8212 external ear melanomas 18 showed that survival after MMS was at least equivalent to that of WLE, but with the benefit of normal tissue preservation. Additionally, Terushkin et al 12 found in their study (n = 1416) that MMS conserved function in digital melanoma by avoiding amputation and was associated with a low local recurrence rate of 0.14%.…”

Section: Mohs Micrographic Surgery For Different Types Of Skin Cancermentioning

confidence: 99%

“…17 However, some studies have shown a negligible difference in recurrence rates between MMS and WLE for melanoma recurrence rates. [18][19][20][21] A retrospective cohort study of the National Cancer Database (n = 53 223) found that treatment of head and neck melanoma with WLE vs. MMS was not significantly associated with OS (HR = 1.094; 95% CI 0.997-1.201). 20 Studies have also shown advantages of MMS for lentigo maligna melanoma (LMM) compared with WLE.…”

Section: Mohs Micrographic Surgery For Different Types Of Skin Cancermentioning

confidence: 99%

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A review of Mohs micrographic surgery for skin cancer. Part 1: Melanoma and rare skin cancers

Charalambides

Yannoulias

Malik

et al. 2022

Clin Experimental Derm

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Summary Mohs micrographic surgery (MMS) is a precise and effective method commonly used to treat high‐risk basal cell carcinoma and squamous cell carcinoma on the head and neck. Although the majority of evidence for MMS relates to keratinocyte cancers, there is published evidence for other types of skin cancer. This review aims to discuss the evidence for using MMS to treat six different types of skin cancer [malignant melanoma, lentigo maligna, dermatofibrosarcoma protuberans, atypical fibroxanthoma (AFX), microcystic adnexal carcinoma and pleomorphic dermal sarcoma (PDS)] particularly in the context of survival rates and cancer recurrence. These cancers were chosen because there was sufficient literature for inclusion and because MMS is most useful when cancers are contiguous, rather than for cancers with marked metastatic potential such as angiosarcoma or Merkel cell carcinoma. We searched MEDLINE, PubMed and Embase using the keywords: ‘melanoma’, ‘mohs micrographic surgery’, ‘lentigo maligna’, ‘dermatofibrosarcoma protuberans’, ‘atypical fibroxanthoma’, ‘microcystic adnexal carcinoma’ and ‘pleomorphic dermal sarcoma’ along with their appropriate synonyms, to identify the relevant English‐language articles from 2000 onwards, given that literature for MMS on nonkeratinocyte cancers is sparse prior to this year. AMSTAR (A MeaSurement Tool to Assess systematic Review) was used to assess the validity of systematic reviews. Further high‐quality, multicentre randomized trials are necessary to establish the indications and efficacy of MMS for rarer cancers, particularly for AFX and PDS, for which only limited studies were identified.

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“…4 Furthermore, the addition of immunohistochemical stains such as MART-1, MEL-5, and SOX-10 may facilitate the accurate interpretation of frozen sections in MMS for LM and thin HNM and even rival the accuracy of conventional histology while permitting peripheral margin control. [2][3][4]11,18,33,[39][40][41] Although the 2012 Appropriate Use Criteria has included the implementation of MMS for MIS, the technique is still underused despite the potential advantages. 7,42 For instance, based on Medicare data until 2013, only 0.3%-3.5% of Mohs cases in the United States were performed on melanomas, 38,43,44 and rates of utilization of Mohs for MIS do not seem to have increased.…”

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confidence: 99%