Cutaneous head and neck melanoma treated with Mohs micrographic surgery

Surgical margins for melanoma in situ

“…The authors previously recommended 9 mm. 25 With 1120 tumors, this study is the largest published to date and confirms 9 mm is needed to achieve 97% clearance. Another reason to use 9 mm is that many histologically proven melanoma in situ are actually invasive.…”

“…[3][4][5][6][7] Nine studies (including the current study) report clearance rate with 5-mm margins to be only 0% to 86% (Table IV). [3][4][5][6][7][24][25][26] Further, residual melanoma in situ is unlikely to be detected by routine bread-loafing sections of the excised specimen 27 and 8% to 20% will recur. [28][29][30] Certainly, we should strive for better.…”

Guidelines of care for the management of primary cutaneous melanoma

“…Particularly for larger lesions on the head and neck, greater than 0.5-cm margins may be necessary to achieve negative margins. 49,50,103 Examination with a Wood lamp may be helpful in the presurgical assessment of subclinical extension. Contralateral sampling by punch biopsy may help distinguish true atypical junctional melanocytic hyperplasia from background actinic damage.…”

Confocal Microscopy and Lentigo Maligna: An in vivo Pilot Study for the Assessment of Response to Imiquimod Therapy

“…In patients with LM, surgical excision is still the gold standard and treatment of choice. Thus, Mohs micrographic surgery was shown to have a recurrence rate of only 3% in a follow-up period of 5 years [19]. Nevertheless, surgical treatment cannot be performed in all cases, either because of comorbidities or because of the risk of poor cosmetic results.…”