No Survival Benefit With Wide Margin Mohs Micrographic Surgery for Melanoma: A National Cancer Database Analysis

O’Hern, Keegan; Liszewski, Walter; Vidal, Nahid Y.; Demer, Addison M.

doi:10.1097/dss.0000000000003804

Dermatol Surg

2023

DOI: 10.1097/dss.0000000000003804

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No Survival Benefit With Wide Margin Mohs Micrographic Surgery for Melanoma: A National Cancer Database Analysis

Keegan O’Hern

Walter Liszewski

Nahid Y. Vidal

et al.

Abstract: O ptimal treatment strategies for melanoma remain controversial, including resection margins in Mohs micrographic surgery (MMS). 1,2 MMS for melanoma is currently performed with varied techniques, including first-stage margins. 3 The objective of this study was to assess factors associated with margin utilization and outcomes of MMS with narrow versus wide margins for melanoma in situ (MIS) and malignant melanoma (MM).A retrospective analysis using the National x Cancer Database (NCDB) was performed; patients … Show more

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2024

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Cited by 2 publications

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No Disease-Specific Survival Benefit With Wide Margin Mohs Surgery for Lentigo Maligna Melanoma

Taylor,

Thomas,

Sharma

et al. 2024

Dermatol Surg

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L entigo maligna melanoma (LMM) represents approximately 4% to 15% of invasive melanoma subtypes and commonly occurs on the head and neck in chronically sun-damaged skin. 1 Surgical removal is considered the gold-standard treatment, and previous studies have reported reduced recurrence rates in LMM when treated with Mohs micrographic surgery (MMS) compared with standard wide local excision. 2 Currently, surgical margins for LMM are based on tumor thickness and can range anywhere from 1 to 3 cm; however, optimal margins in the context of MMS are still a point of debate. 3 Herein, this study aims to evaluate disease-specific survival (DSS) of patients with LMM treated with narrow and wide surgical margin-MMS.The 2000 to 2020 Surveillance, Epidemiology, and End Results (SEER) database was used to identify biopsyconfirmed cases of LMM patients (ICD-O-3 histology code 8,742/3; primary site code C44.0-44.9) treated with MMS. Patients with lentigo maligna (in situ) and distant-stage disease were excluded from this study. Surgical margins for MMS were defined by the SEER database as narrow (#1 cm) or wide (.1 cm). Statistical analysis was completed using SPSS version 29.0 and included Chi-squared, Mann-Whitney U, Kaplan-Meier and log-rank, and multivariate Cox proportional hazards (significance p , .05).A total of 514 patients were identified, of which 84.4% were treated with narrow-margin MMS and 15.6% with wide-margin MMS (Table 1). Majority identified as male (66.5%), ages 70 to 79 (31.1%), with localized disease (98.4%), and having tumors located on the head and neck (72.9%). There was a significant association between margin size and rural/urban living (p 5 .024), where higher rates of urban patients received treatment with wide-margin MMS (17.0% vs 6.8%), whereas rural patients more frequently underwent narrow-margin MMS (93.2% vs 83.0%). On univariate Kaplan-Meier analysis, there was no significant difference in 5-and 10-year DSS rates between patients treated with narrow (96.0% and 95.0%) and wide margins (97.0% and 91.0%) (p 5 .70; See Supplemental Digital Content 1, Figure 1, http://links.lww. com/DSS/B487). A multivariate Cox regression adjusting for age, sex, rural-urban living, annual income, localized/ regional disease stage, and Breslow thickness revealed no significant difference in disease-specific mortality risk between wide and narrow-margin MMS (reference: narrow margins; aHR 3.37; 95% CI 0.25-45.96; p 5 .36).To our knowledge, this study is the first to compare DSS outcomes between narrow and wide-margin MMS for invasive LMM patients. A previous study by Zitelli and colleagues 4 found that surgical margins of 1.5 cm were required to excise 97% of LMs and LMMs of the head and neck. By contrast, a retrospective cohort analysis by O'Hern

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No Disease-Specific Survival Benefit With Wide Margin Mohs Surgery for Lentigo Maligna Melanoma

Taylor,

Thomas,

Sharma

et al. 2024

Dermatol Surg

View full text Add to dashboard Cite

show abstract

No improved disease‐specific survival with wide margin Mohs surgery for malignant melanoma of the skin: a retrospective cohort analysis

Taylor,

Thomas,

Sharma

et al. 2024

Int J Dermatology

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No Survival Benefit With Wide Margin Mohs Micrographic Surgery for Melanoma: A National Cancer Database Analysis

Cited by 2 publications

References 4 publications

No Disease-Specific Survival Benefit With Wide Margin Mohs Surgery for Lentigo Maligna Melanoma

No Disease-Specific Survival Benefit With Wide Margin Mohs Surgery for Lentigo Maligna Melanoma

No improved disease‐specific survival with wide margin Mohs surgery for malignant melanoma of the skin: a retrospective cohort analysis

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