Systematic Review of Technical Variations for Mohs Micrographic Surgery for Melanoma

Abstract

BACKGROUND Mohs micrographic surgery (MMS) for cutaneous melanoma is becoming more prevalent, but surgical technique varies. OBJECTIVE To define variations in published techniques for MMS for melanoma. METHODS AND MATERIALS A systematic review was performed of PubMed, EMBASE, and Scopus databases to identify all articles describing surgical techniques for MMS for melanoma. Technical details were recorded for the preoperative, intraoperative, and postoperative phases of MMS. RESULTS Twenty-four articles were included. Mohs surgeons vary in how they assess clinical margins, how wide a margin they excise on the first MMS layer, and how they process tissue to determine tumor stage and margin clearance during MMS for melanoma. CONCLUSION Mohs micrographic surgery for melanoma is performed with varied surgical techniques. To establish best practices, additional research is necessary to determine how different techniques affect outcomes.

European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2022

“…Because of unpredictable subclinical extension of the adjacent intraepidermal component, the management of lentigo maligna melanoma may range from a 5 mm margin to wider margins (up to 10 mm). For larger lentigo maligna and lentigo maligna melanoma, microscopically controlled surgery is a recommended option and is usually performed following any of the technical variations developed (frozen section Mohs micrographic surgery, paraffin-embedded, "slow Mohs", and 3D-histology) [21,22].…”

Assessing Rates of Positive Surgical Margins After Standard Excision of Vulvar Melanomas

“…57–59 Because there is substantial interfacility variation in MMS for melanoma technique, and vulvar melanoma specifically is a rare subtype with unique challenges, initial efforts to establish MMS as a standard treatment for vulvar melanoma may be more effective at centers with experience with the procedure and access to multiple surgical specialties to coordinate care for these patients. 60,61…”

Local Recurrence Rates of Malignant Melanoma After Mohs Micrographic Surgery Are Lowest With 5- to 10-mm Initial Margins: A Systematic Review and Meta-Analysis

“…[7][8][9] Some initial evidence, based on a secondary outcome of a meta-analysis, signaled a potentially lower recurrence rate with larger margins; however, this study included a fraction of the available literature due to this being a secondary outcome. 10 This study is the first with a primary objective to determine differences in local recurrence based on initial margins used in MMS for melanoma. There is also no evidence to determine whether initial surgical margin impacts total number of stages.…”