Permanent section margin concordance after Mohs micrographic surgery with immunohistochemistry for invasive melanoma and melanoma in situ: A retrospective dual-center analysis

Young, Jade N; Nguyen, Thao Thi Thu; Freeman, S. Caleb; Hill, Emma; Johnson, Mariah; Gharavi, Nima M.; Bar, Anna; Leitenberger, Justin J.

doi:10.1016/j.jaad.2023.01.019

Cited by 9 publications

(6 citation statements)

References 27 publications

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“…The authors found exceptionally high levels of concordance between MART-1 frozen sections and permanent pathology sent during MMS for MIS and invasive melanomas. 24 A recent, retrospective, multicenter analysis further highlighted the efficacy of MMS when combined with MART-1 immunostaining, recording local, nodal, and distant recurrence rates of 0.51%, 1%, and 1.1%, respectively. 25 These findings refute the previously held dogma that permanent margins are required for histologic section analysis in melanomas.…”

Section: From Centimeters To Millimetersmentioning

confidence: 99%

“…However, with advances in IHC, including faster and more reliable staining protocols, recent data suggest that MMS is becoming increasingly used. 26 Given increased training and comfort among technicians and surgeons, 26 the high concordance rates between frozen and permanent sections, 24 and the superior clinical outcomes, [13][14][15][16][17][18][19] we recommend MMS with IHC in laboratories with established proficiency for the surgical management of melanoma.…”

Section: From Centimeters To Millimetersmentioning

confidence: 99%

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From Centimeters to Millimeters: The Evolution of the Surgical Margins for Melanoma—A Historical Review

Rosenthal,

Juhasz,

Lask

et al. 2023

Dermatol Surg

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BACKGROUND With an improved understanding of tumor biology and behavior, the recommended margins for the surgical treatment of melanoma have evolved. OBJECTIVE We describe the progression of these surgical margins, detailing the historical basis for the 5-cm margin and transitioning to current practice, in which Mohs micrographic surgery (MMS) with immunohistochemistry (IHC) has become increasingly used. METHODS/MATERIALS We searched PubMed and Google Scholar for articles published between January 2019 and April 2023 describing the use of MMS for melanoma in situ (MIS) and invasive melanomas. RESULTS We identified 12 articles focusing on the use of MMS for MIS and invasive melanomas: 3 meta-analyses and 9 retrospective studies. Two retrospective analyses documented no differences in overall survival between MMS and wide local excision (WLE) and 2 found improved overall survival for MMS compared with WLE. Three retrospective analyses and 3 meta-analyses demonstrated low recurrence rates after the use of MMS for both MIS and invasive melanomas. Finally, 2 retrospective studies documented the success of MMS with IHC using MART-1. CONCLUSION Over the past century, the surgical margins for the treatment of melanoma have undergone a marked transformation. MMS with IHC has become increasingly popular given its ability to reliably produce superior clinical outcomes.

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Section: From Centimeters To Millimetersmentioning

confidence: 99%

Section: From Centimeters To Millimetersmentioning

confidence: 99%

From Centimeters to Millimeters: The Evolution of the Surgical Margins for Melanoma—A Historical Review

Rosenthal,

Juhasz,

Lask

et al. 2023

Dermatol Surg

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“…A recent study examining over 400 patients undergoing MMS for melanoma demonstrated a 97% concordance of frozen sections with permanent margins (Table 1). 32…”

Section: Immunohistochemical Stains In Melanomamentioning

confidence: 99%

“…28 Except for desmoplastic melanoma, high rates of sensitivity and specificity for detecting melanoma and high concordance with permanent sections have been reported for MART-1. [29][30][31][32] Bhatt and colleagues performed a prospective cohort study of MART-1 sensitivity and specificity in detecting melanoma on frozen sections in a combined sample of 169 IM and MIS specimens. They found the sensitivity was 95.3% (confidence interval [CI], 89.6%-98.1%) and the specificity was 95.1% (CI, 82.2%-99.2%) for detecting melanoma on frozen section by a Mohs surgeon compared with a dermatopathologist's permanent section interpretation of the same specimen (Table 1).…”

Section: Melanoma Antigen Recognized By T Cellsmentioning

confidence: 99%

“…A recent study examining over 400 patients undergoing MMS for melanoma demonstrated a 97% concordance of frozen sections with permanent margins (Table 1). 32 Using IHC stains has also been shown to decrease the risk of tumor recurrence. A 2021 meta-analysis of 13,998 patients examined recurrence rates for melanoma of the head and neck treated with MMS with and without IHC staining.…”

Section: Melanoma Antigen Recognized By T Cellsmentioning

confidence: 99%

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An Update and Review of Clinical Outcomes Using Immunohistochemical Stains in Mohs Micrographic Surgery for Melanoma

Elgash,

Young,

White

et al. 2023

Dermatol Surg

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BACKGROUND Mohs micrographic surgery (MMS) provides optimal margin control through complete peripheral and deep margin assessment. The treatment of melanoma using MMS has historically been limited by difficulty in interpreting melanocytes using frozen sections. Immunohistochemical (IHC) staining, a technique whereby chromogen-tagged antibodies are used to detect antigens of interest, has revolutionized the surgical treatment of melanoma. OBJECTIVES This article provides an update and literature review of current IHC stains used in MMS for melanoma, their sensitivities and specificities, and clinical outcomes. MATERIALS AND METHODS A PubMed search was performed using keywords including “immunohistochemistry,” “staining,” and “Mohs surgery.” Articles related to the use of IHC staining for the treatment of melanoma with MMS were included. RESULTS Six IHC stains met the criteria for the review including melanoma antigen recognized by T cells (MART-1), SRY-related HMG-box (SOX10), microphthalmia-associated transcription factor, HMB-45, MEL-5, S-100, and preferentially expressed antigen in melanoma. CONCLUSION The adaptation of IHC methods to frozen sections has enabled MMS to become a preferred treatment option for melanoma in special-site areas. Future studies are needed to standardize IHC techniques and to define best practices when using frozen section in the treatment of melanoma.

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Excision margins for melanoma in situ on the head and neck—A single-center 10-year retrospective review of treatment with Mohs micrographic surgery

Tate,

Matsumoto,

Greif

et al. 2024

Journal of the American Academy of Dermatology

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Permanent section margin concordance after Mohs micrographic surgery with immunohistochemistry for invasive melanoma and melanoma in situ: A retrospective dual-center analysis

Cited by 9 publications

References 27 publications

From Centimeters to Millimeters: The Evolution of the Surgical Margins for Melanoma—A Historical Review

From Centimeters to Millimeters: The Evolution of the Surgical Margins for Melanoma—A Historical Review

An Update and Review of Clinical Outcomes Using Immunohistochemical Stains in Mohs Micrographic Surgery for Melanoma

Excision margins for melanoma in situ on the head and neck—A single-center 10-year retrospective review of treatment with Mohs micrographic surgery

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