Systematic Review of the Role of Mohs Micrographic Surgery in the Management of Early-Stage Melanoma of the Head and Neck

Theunissen, Chantal C W; Lee, Ming Hua; Murad, Fadi; Waldman, Abigail

doi:10.1097/dss.0000000000003126

Cited by 12 publications

(6 citation statements)

References 46 publications

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“…[22][23][24][25]28,29 Typically, MIS is treated with 5-mm excision margins, but difficulties can arise when MIS is located in sun-exposed regions. 30 The systematic review of 32 articles published by Theunissen et al 31 showed that MMS had lower local recurrence rates for early-stage melanomas compared with staged excision and WLE: pooled recurrence risk 0.8% (95% CI 0.4-1.1) vs. 2.5% (95% CI 1.5-3.4) vs. 8.7% (95% CI 5.1-12.2) (P = 0.001), respectively. Similarly, Nosrati et al 32 (n = 662) found overall recurrence rates of 1.8% for MMS compared with 5.7% for WLE (P = 0.07) for MIS.…”

Section: Melanoma In Situ and Lentigo Malignamentioning

confidence: 99%

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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Section: Melanoma In Situ and Lentigo Malignamentioning

confidence: 99%

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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“…An evolving body of literature continues to demonstrate higher cure rates, lower local recurrence rates, and equivalent or superior survival for melanoma treated with Mohs micrographic surgery (MMS) compared with staged excision (SE), and/or wide local excision (WLE). 1–8 A recent systematic review and meta-analysis that compiled the largest dataset to date for head and neck melanoma (HNM) showed lower overall recurrences when treating melanoma in situ (MIS) and invasive melanoma with MMS or SE compared with WLE. 7 Another recent systematic review concluded MMS has a lower local recurrence rate for early-stage melanoma over SE and WLE.…”

mentioning

confidence: 99%

“…7 Another recent systematic review concluded MMS has a lower local recurrence rate for early-stage melanoma over SE and WLE. 8 However, only a minority of Mohs surgeons treat melanoma with MMS. 9–15 Given that general dermatologists play a vital role in treating and referring patients with melanoma, this nationwide cross-sectional survey sought to investigate the practice habits and referral preferences of general dermatologists regarding MMS for treating melanoma on the head and neck.…”

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confidence: 99%

Factors Influencing General Dermatologists When Referring Patients With Head and Neck Melanoma for Mohs Micrographic Surgery: A Nationwide Cross-Sectional Survey

et al. 2023

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BACKGROUNDMohs micrographic surgery (MMS) for cutaneous melanoma has demonstrated higher cure rates, lower local recurrence rates, and improved survival compared with wide local excision (WLE). However, factors affecting referrals by general dermatologists for MMS of head and neck melanoma (HNM) are unknown.OBJECTIVETo elucidate referral factors and treatment perspectives of general dermatologists regarding MMS for melanoma in situ (MIS)/lentigo maligna (LM) and early-stage melanoma on the head and neck.MATERIALS AND METHODSA cross-sectional analysis was performed using survey responses of general dermatologists with membership in the American Academy of Dermatology.RESULTSA total of 231 and 132 of the 402 responding general dermatologists routinely referred melanoma in situ MIS/LM and early invasive melanoma for MMS, respectively. Lack of local access to a Mohs surgeon was the most common deterring reason for MIS/LM referral to MMS, whereas the preference for WLE was the most common deterring reason for early invasive melanoma.CONCLUSIONLack of local access to a Mohs surgeon treating HNM with MMS is the primary barrier in referrals to Mohs surgeons for MIS and LM. Among general dermatologists, WLE is preferred for early invasive HNM.

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“…1 Data have emerged supporting this practice, highlighting lower rates of recurrence with Mohs and complete circumferential peripheral and deep margin assessment over conventional wide local excision. [2][3][4][5] Specific practice patterns vary, as do outcomes among treatment facilities with differing volumes. 6 With these discrepancies come a calling for standardization of best practices.…”

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confidence: 99%

Commentary on “Recurrence Rate for Melanoma Excised by Mohs Micrographic Surgery Without Immunostaining”

Council

2022

Dermatol Surg

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M ohs micrographic surgery is becoming an increasingly utilized therapy for noninvasive and early-stage melanoma of the head and neck. 1 Data have emerged supporting this practice, highlighting lower rates of recurrence with Mohs and complete circumferential peripheral and deep margin assessment over conventional wide local excision. [2][3][4][5] Specific practice patterns vary, as do outcomes among treatment facilities with differing volumes. 6 With these discrepancies come a calling for standardization of best practices. In this edition of Dermatologic Surgery, Vieira and colleagues 7 publish a retrospective cohort study of 224 cases of cutaneous melanoma treated at a tertiary academic center with Mohs micrographic surgery, without immunostaining, by a single surgeon.The technique utilized in the study was outlined thoroughly in the article. To begin, a standard 5-mm margin was taken for all melanomas, with narrower margins considered on a case-by-case basis. The current guidelines of the National Comprehensive Cancer Network 8 recommend a wide local excision to the level of fascia with 1-cm margins for T1a melanoma, and a margin of 0.5 to 1 cm for melanoma in situ. The guidelines caution that more narrow margins may increase the risk for margin positivity and/or local recurrence. In fact, the guidelines stress that "the gold standard for histologic assessment of excised melanoma is use of permanent sections" and state that Mohs surgery "may be considered selectively for minimally invasive (T1a) melanomas in anatomically constrained areas". Despite data showing equivalent or superior outcomes, there remains resistance to the acceptance of Mohs surgery for invasive melanoma.The second point of discussion is that immunostains were not utilized in this study. The majority of Mohs surgeons performing Mohs surgery on melanoma in situ and invasive melanoma today do utilize immunohistochemistry, 9 but this, too, is a source of dissension. A recent review of technical variations for Mohs micrographic surgery for melanoma reported that 45.8% of surgeons utilized MART-1, 20.8% utilized other immunohistochemistry (IHC) either in place of or in addition to MART-1, such as HMB-45, MEL-5, and S100, and 33.3% did not use IHC at all.

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Systematic Review of the Role of Mohs Micrographic Surgery in the Management of Early-Stage Melanoma of the Head and Neck

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 12 publications

References 46 publications

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

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

Factors Influencing General Dermatologists When Referring Patients With Head and Neck Melanoma for Mohs Micrographic Surgery: A Nationwide Cross-Sectional Survey

Commentary on “Recurrence Rate for Melanoma Excised by Mohs Micrographic Surgery Without Immunostaining”

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