Mohs micrographic surgery versus wide local excision for melanoma in situ: analysis of a nationwide database

Abstract

Background With the rising incidence of melanoma in situ (MIS) or cutaneous melanoma, there is an increasing emphasis on the need to understand optimal treatment strategies. The current standard of surgical care is wide local excision (WLE). Alternative surgical techniques have been proposed including Mohs micrographic surgery (MMS). We aimed to compare survival rates following WLE versus MMS surgery for MIS. Methods We performed a retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) cancer registry. 24,515 cases of WLE were identified and compared with 4122 cases of MMS surgery for MIS. Results There was a significantly higher proportion of elderly patients aged ≥75 years in the MMS group compared to WLE (23.3% vs. 15.3%). The proportion of females was higher for WLE compared to MMS (48.8% vs. 40%). Facial MIS tumors were significantly higher for MMS, as were scalp/neck tumors. After adjustment for confounding factors, there was no significant difference in cancer‐specific survival (HR 0.928, 95% CI 0.596–1.446, P = 0.74) and overall survival (HR 1.006, 95% CI 0.896–1.129, P = 0.924). Conclusion Adjusted analyses demonstrated no differences in overall survival or cancer‐specific survival between MIS patients treated with MMS compared with WLE.

Histological Peripheral Margins and Recurrence of Melanoma In Situ Treated with Wide Local Excision

“…Compared to WLE, MMS offers the possibility of total margin evaluation and has been associated with decreased rates of recurrence [ 33 ]. Other recent studies contradict these findings by suggesting no differences in overall survival, cancer-specific survival, and recurrence rates amongst patients treated with MMS and WLE [ 29 , 39 ]. There is a misconception that MMS is more costly than WLE, but recent preliminary work [ 34 ] would imply that MMS is more cost-effective than WLE, particularly with an increased incidence of skin cancers [ 1 ].…”

Treatment of Cutaneous Melanoma of the Head and Neck With Wide Local Excision Versus Mohs

“…It is in cases of melanoma in situ, and in particular lentigo maligna, where MMS can be a very powerful technique in clearing the disease and obtaining very low local recurrence rates 4 . However, some retrospective institutional and database studies have found no difference in local control rates or overall survival in melanoma in situ patients treated with MMS versus WLE 23,24 . It is likely that both MMS and WLE are effective treatment options for most CMHN, with MMS outperforming WLE in cases of subclinical spread beyond the visible borders of the lesion.…”

Effect of Ulceration on the Therapeutic Benefit of Surgery in Patients with Stage IV Melanoma: A Surveillance, Epidemiology, and End Results Analysis from 2004–2015

“…A metastasectomy is recommended for patients with metastatic melanoma by the National Comprehensive Cancer Network guidelines 18 ; however, the guidelines lack proper descriptions regarding whether primary tumor resections should be routinely practiced in advanced melanoma patients or not, and the conclusions are limited by conditions such as solitary lesions. Selection bias may be contributing to observed associations between survival benefit and surgery in previous retrospective studies 6,8,11,19,20 .…”