Long-term outcomes of Mohs micrographic surgery for invasive melanoma of the trunk and proximal portion of the extremities

Burnett, Mark E.; Brodland, David G.; Zitelli, John A.

doi:10.1016/j.jaad.2020.07.113

Cited by 22 publications

(25 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our mean margin for IM of the trunk was 13.4 mm (Table 2). A recent prospective study by Burnett and colleagues 20 demonstrated that MMS is useful in the trunk and extremity to identify T1a-b melanomas that require >10-mm of margin for tumor excision.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, other studies of similar designs largely estimate surgical margins based on a 3-mm layer taken at each stage. 5,7,9,10,16,20 At our practice, margin thickness is not evaluated at every surgical stage, because it is dependent on tumor characteristics, location, and directionality of involvement. As such, our margins were calculated based on the difference between the final defect size and the clinical size of the lesion.…”

Section: Margin Assessmentmentioning

confidence: 99%

See 1 more Smart Citation

Recurrence Rate for Melanoma Excised by Mohs Micrographic Surgery Without Immunostaining

Vieira

Jennings

Renzi

et al. 2022

View full text Add to dashboard Cite

BACKGROUND Mohs micrographic surgery (MMS) is becoming increasingly popular for the treatment of cutaneous melanoma (CM) as multiple studies have demonstrated favorable outcomes for local recurrence and overall survival. OBJECTIVE To analyze the outcomes of noninvasive (NIM) and invasive melanomas (IM) using MMS with fresh frozen sections. The primary outcome was local recurrence. The secondary outcome was to identify mean surgical margins based on tumor type and location. METHODS Retrospective cohort study of 224 cases of CM treated from 2006 to 2016 at a tertiary academic center with MMS and fresh frozen sections by a single Mohs surgeon. RESULTS The overall recurrence rate was 2.6% with a mean follow-up of 36.2 months. The recurrence rate for NIM versus IM was 1.6% and 7%, respectively. The mean margins for NIM and IM were 7.9 mm and 10.1 mm, respectively. These varied by tumor site and location. CONCLUSION This study supports the use of MMS in the treatment of CM and highlights how narrower surgical margins for NIM of the head and neck can be achieved without increasing risk of local recurrence.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Margin Assessmentmentioning

confidence: 99%

Recurrence Rate for Melanoma Excised by Mohs Micrographic Surgery Without Immunostaining

Vieira

Jennings

Renzi

et al. 2022

View full text Add to dashboard Cite

show abstract

“…14,15,[38][39][40][41] Subsequently, studies began to demonstrate improved recurrence rates after transitioning to exclusively using MART-1. 21,33,36 In a recent study by Burnett et al, 37 a retrospective analysis of IM on the trunk and proximal extremities treated by MMS observed only 2 (0.14%) recurrences. The authors established that the sample included procedures that utilized H&E alone, then DISCUSSION HMB, then MART-1 exclusively.…”

Section: Risk Of Biasmentioning

confidence: 97%

“…The transition to MART-1 from H&E alone and/or HMB-45 took place in many important retrospective studies. 14,20,21,33,36,37 This transition appeared to occur around 2002, when further investigation suggested MART-1 was the superior immunohistochemistry stain in frozen sections due to reliable epidermal staining, ease of interpretation, and highest histopathologic concordance. 14,15,[38][39][40][41] Subsequently, studies began to demonstrate improved recurrence rates after transitioning to exclusively using MART-1.…”

Section: Risk Of Biasmentioning

confidence: 99%

Melanoma Recurrence after Mohs Micrographic Surgery with MART-1: A Systematic Review and Meta-analysis

Long¹,

Dunn²,

Arndt³

et al. 2021

J of Skin

View full text Add to dashboard Cite

Background: Surveys suggest wide-spread use of MART-1 in MMS for CM among Mohs surgeons, but no previous systematic review has investigated the efficacy of this specific procedure. Methods: A systematic search and meta-analysis of retrospective studies on MMS with MART-1 was performed from Pubmed, Medline, and Cochrane databases for articles published from their inception to October 30, 2020. We performed a chi-squared analysis of homogenized data to examine the relationship between recurrence location and rate of recurrence. A risk of bias was obtained with the ROBINS-I tool. [PROSPERO ID: CRD42020221826] Results: Among the included studies, there were a total of 15 (0.52%) local recurrences of melanoma in-situ and invasive melanoma after MMS with MART-1. Conclusions: This review has served to demonstrate that MMS with MART-1 immunostaining in frozen sections is a technique that produces satisfactory recurrence rates for melanoma in-situ and invasive melanoma.

show abstract

“…Melanoma and lentigo maligna melanoma WLE is the recommended treatment for melanoma, 5 and uses a set clinical margin taken around the lesion depending on Breslow thickness; nevertheless, some studies have shown that MMS, particularly for earlystage melanoma on the head, may be associated with improved rates of cancer recurrence, [6][7][8][9][10][11][12][13][14][15] overall survival (OS), 10,16,17 melanoma-specific survival 8,10,14,17 and metastasis. 14 The meta-analysis published by Bittar et al 6 demonstrated lower local recurrence rates for cutaneous head and neck melanoma after treatment with MMS (0.61%; 95% CI 0.1%-1.4%) vs. staged excision (1.8%; 95% CI 1.0%-2.9%) and WLE (7.8%; 95% CI 6.4%-9.3%).…”

Section: Mohs Micrographic Surgery For Different Types Of Skin Cancermentioning

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

View full text Add to dashboard Cite

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.

show abstract

Long-term outcomes of Mohs micrographic surgery for invasive melanoma of the trunk and proximal portion of the extremities

Cited by 22 publications

References 51 publications

Recurrence Rate for Melanoma Excised by Mohs Micrographic Surgery Without Immunostaining

Recurrence Rate for Melanoma Excised by Mohs Micrographic Surgery Without Immunostaining

Melanoma Recurrence after Mohs Micrographic Surgery with MART-1: A Systematic Review and Meta-analysis

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

Contact Info

Product

Resources

About