Mohs Micrographic Excision of Lentigo Maligna Using Mel-5 for Margin Control

Staged excision for lentigo maligna and lentigo maligna melanoma: A retrospective analysis of 117 cases

“…24 The reliability of frozen sections for interpreting melanoma in situ compared with paraffin-embedded sections has been questioned with Zitelli et al 22 reporting 100% sensitivity and 90% specificity whereas others report lower sensitivity and specificity rates of 73% and 68%, respectively. 12 Immunostains with HMB-45, S-100, MART-1, and Mel-5 have been advocated 11,[25][26][27][28] to overcome frozen section difficulties of freeze artifact and distinguishing actinically damaged keratinocytes from melanocytes, but require additional processing time. An alternative approach is to use frozen sections until a negative margin is achieved and then confirm final margins with permanent sections.…”

Surgical Margins for Lentigo Maligna and Lentigo Maligna Melanoma

“…24,33,34 Recurrence rates for these techniques with follow-up ranging from 2 to 9 years have ranged from 0.5% to 3%. 9,10,[22][23][24][25][26][27][28][29][30][31][32][33][34] The best results were obtained by Zitelli et al, 10,22 using a modified form of Mohs surgery with frozen-section margin control and vertical paraffin sections of the central tumor, with a recurrence rate of 0.5% at 5 years for 184 in situ melanomas, of which 106 were on the head and neck.…”

Current Progress of Immunostains in Mohs Micrographic Surgery: A Review

“…27,[39][40][41][42][43] The use of immunostains can aid in interpretation of such atypical melanocytic hyperplasia and has been advocated as an efficacious way to differentiate melanoma from such hyperplasia, although there is still controversy over the utility of Mohs surgery for melanoma, despite several studies documenting its efficacy and strong longterm cure rates that are equal to, if not better than, that of wide local excision. 3,10,11,13,24,25,[30][31][32][44][45][46][47][48][49][50][51] …”

“…52,53 A debulking specimen including a few millimeters of lateral margin and subcutaneous fat can be sent for permanent sectioning for full assessment of Breslow thickness, bisected for use as a positive control for staining, or both. 1,3,13 For obtaining Mohs layers, some favor taking sections with a nearly perpendicular angle, because tangential (beveled) cuts may result in a false positive at the periphery revealing a high melanocytic density. 1 When margins are clear for outright melanoma but atypical melanocytic hyperplasia remains, there are no current guidelines as to whether additional tissue should be removed.…”

“…This entails performing a contralateral, same-site skin biopsy that acts as a negative control, with the center of the tumor acting as a positive control. 13 An alternative method of obtaining control tissue is to biopsy adjacent skin a few centimeters away from the presumed tumor edge. Such lesion-controlled pathologic correlations give the surgeon a method to determine whether the peritumoral hyperplasia is relevant or not.…”