Mohs Micrographic Surgery for Melanoma

Miller, Christopher J.; Giordano, Cerrene N.; Higgins, H. William

doi:10.1001/jamadermatol.2019.2589

Cited by 12 publications

(5 citation statements)

References 10 publications

(26 reference statements)

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“…Such guidelines may serve to reduce variations in practices and patient outcomes between facilities as has occurred after the establishment of consensus recommendations for other surgical procedures . It has also been proposed that further improvements in the quality of care and outcomes achieved by surgeons performing MMS for melanoma across centers may be achieved by the establishment of training standards for the procedure as has been successfully executed for head and neck robotic surgery, another novel oncologic procedure …”

Section: Discussionmentioning

confidence: 99%

Association of Treatment Facility Characteristics With Overall Survival After Mohs Micrographic Surgery for T1a-T2a Invasive Melanoma

et al. 2021

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elanoma is one of the most common cancers in the US, with 106 110 incident cases estimated to be diagnosed in 2021. 1 Although the standard therapy for localized invasive melanoma is wide local excision, Mohs micrographic surgery (MMS) has been increasingly used as an alternative excisional approach, [2][3][4] with a recent study reporting that 7.9% of surgical melanoma cases in 2016 were excised using MMS. 5 Mohs micrographic surgery offers the advantage of complete margin evaluation during the procedure while potentially limiting healthy tissue removal. Such complete margin evaluation is especially helpful in the case of facial tumors, for which National Comprehensive Cancer Network guidelines state that margins may be reduced for anatomic considerations, or tumors with clinically indistinct borders, such as lentigo maligna melanoma, for which appropriate margins may be difficult to determine clinically. 2,6 Recent work suggests that treatment of early-stage (T1a-T2a category) melanoma with MMS is associated with a modest survival advantage compared with traditional wide local excision. 7 An additional consideration for the more technically complex MMS for melanoma procedure is how effectively it can be applied across centers. Although studies of resections for other cancers have reported that facility-level factors are associated with patient outcomes, it is not yet established how such factors may IMPORTANCE Early-stage melanoma, among the most common cancers in the US, is typically treated with wide local excision. However, recent advances in immunohistochemistry have led to an increasing number of these cases being excised via Mohs micrographic surgery (MMS). Although studies of resections for other cancers have reported that facility-level factors are associated with patient outcomes, it is not yet established how these factors may affect outcomes for patients treated with Mohs micrographic surgery.OBJECTIVE To evaluate the association of treatment center academic affiliation and case volume with long-term patient survival after MMS for T1a-T2a invasive melanoma. DESIGN, SETTING, AND PARTICIPANTSIn a retrospective cohort study, 4062 adults with nonmetastatic, T1a-T2a melanoma diagnosed from 2004 to 2014 and treated with MMS in the National Cancer Database (NCDB) were identified. The NCDB includes all reportable cases from Commission on Cancer-accredited facilities and is estimated to capture approximately 50% of all incident melanomas in the US. Multivariable survival analyses were conducted using Cox proportional hazards models. Data analysis was conducted from February 27 to August 18, 2020. EXPOSURES Treatment facility characteristics.MAIN OUTCOMES AND MEASURES Overall survival. RESULTSThe study population included 4062 patients (2213 [54.5%] men; median [SD] age, 60 [16.3] years) treated at 462 centers. Sixty-two centers were top decile-volume facilities (TDVFs), which treated 1757 patients (61.9%). Most TDVFs were academic institutions (37 of 62 [59.7%]). On multivariable analysis, treatment at an aca...

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Section: Discussionmentioning

confidence: 99%

Association of Treatment Facility Characteristics With Overall Survival After Mohs Micrographic Surgery for T1a-T2a Invasive Melanoma

et al. 2021

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“…2 With lower rates of postoperative complications, this study also suggests a short-term morbidity benefit, despite the fact that MMS typically requires tissue-rearranging reconstruction more frequently than WLE. 3 In conjunction with minimizing complications, most of the MMS cases are completed outpatient under local anesthetic, often leading to significant cost-saving benefits to the patient, hospital, and payor. 4 Far more patients receiving WLE underwent sentinel lymph node biopsy, likely because of a higher proportion of low-stage tumors treated with MMS.…”

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confidence: 99%

“…5 Additionally, findings from this database may not be applicable to community-based settings, especially in an era without expert-consensus guidelines and thus practice variation. 3 Further study is needed to assess additional long-term clinical and access-to-care outcomes not discernible from a global data set.…”

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confidence: 99%

Clinical Outcomes of Primary Cutaneous Melanomas Treated With Mohs Micrographic Surgery Versus Wide Local Excision: A Multicenter Cohort Analysis

Sharma,

Hedayati,

Soleymani

2024

Dermatol Surg

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All patients had defects that involved a significant portion of the lower eyelid anterior lamella and periorbital tissue without violation of the eyelid margin or posterior lamella. The defect area ranged from 6.0 cm 2 to 28.0 cm 2 with an average defect area of 12.29 cm 2 . A FTSG was used for 12 (80%) of the cases. Complication review demonstrated no flap failures, no postoperative lagophthalmos, and no postoperative cicatricial ectropion. All patients were pleased with the functional and cosmetic results (Figure 1D). DiscussionThe Tripier or "bucket handle" flap is an excellent choice for repair of lower eyelid defects such as those seen after Mohs micrographic surgery and for repair of lower eyelid cicatricial ectropion. The Tripier flap has excellent vascularity, mainly coming from the palpebral arteries and superior peripheral arcade. The flap provides substantial support, retaining good aesthetic appeal and function. [1][2][3][4] Complications are uncommon, and the ability to avoid cicatricial changes is one of strengths of this flap.

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“…Optimal treatment strategies for melanoma remain controversial, including resection margins in Mohs micrographic surgery (MMS). 1,2 MMS for melanoma is currently performed with varied techniques, including first-stage margins. 3 The objective of this study was to assess factors associated with margin utilization and outcomes of MMS with narrow versus wide margins for melanoma in situ (MIS) and malignant melanoma (MM).…”

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confidence: 99%

No Survival Benefit With Wide Margin Mohs Micrographic Surgery for Melanoma: A National Cancer Database Analysis

et al. 2023

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O ptimal treatment strategies for melanoma remain controversial, including resection margins in Mohs micrographic surgery (MMS). 1,2 MMS for melanoma is currently performed with varied techniques, including first-stage margins. 3 The objective of this study was to assess factors associated with margin utilization and outcomes of MMS with narrow versus wide margins for melanoma in situ (MIS) and malignant melanoma (MM).A retrospective analysis using the National x Cancer Database (NCDB) was performed; patients with MIS and MM undergoing MMS between 2004 and 2019 were included. Variables were categorized into patient (age, sex, comorbidity status, and insurance status) and lesion (location, histology, stage, and Breslow) characteristics for analysis; patient race was

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Mohs Micrographic Surgery for Melanoma

Cited by 12 publications

References 10 publications

Association of Treatment Facility Characteristics With Overall Survival After Mohs Micrographic Surgery for T1a-T2a Invasive Melanoma

Association of Treatment Facility Characteristics With Overall Survival After Mohs Micrographic Surgery for T1a-T2a Invasive Melanoma

Clinical Outcomes of Primary Cutaneous Melanomas Treated With Mohs Micrographic Surgery Versus Wide Local Excision: A Multicenter Cohort Analysis

No Survival Benefit With Wide Margin Mohs Micrographic Surgery for Melanoma: A National Cancer Database Analysis

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