The Current State of Mohs Surgery for the Treatment of Melanoma: A Nationwide Cross-Sectional Survey of Mohs Surgeons

Siscos, Spyros M.; Neill, Brett C.; Seger, Edward W.; Hooton, Tyler A.; Hocker, Thomas L.

doi:10.1097/dss.0000000000002645

Cited by 14 publications

(27 citation statements)

References 20 publications

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“…12 The histopathological assessment of melanocytic skin lesions is associated with considerable difficulty, particularly regarding MIS. [13][14][15][16][17] The intraobserver reproducibility from 187 pathologists who diagnosed MIS on H&E sections had only 60% agreement when the same slides were reviewed at least 8 months later. 14 The same study found only 40% interobserver agreement for the diagnosis of MIS when checked against a reference standard.…”

Section: Discussionmentioning

confidence: 99%

Immunostained Frozen Sections Vs Traditional Permanent Paraffin Sections for Lentigo Maligna Treated With Mohs Micrographic Surgery

Punchihewa

Odhavji

Upjohn

et al. 2021

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BACKGROUND Mohs micrographic surgery (MMS) has risen in popularity as a management option for treating lentigo maligna (LM) because of its ability to accurately detect subclinical spread while conserving tissue. The primary concern for opponents of MMS in melanoma remains the difficulty associated with interpretation of frozen sections compared with traditional paraffin sections; this has been made easier with the advent of immunostaining. OBJECTIVE Our study aims to assess the concordance in clearance reporting of LM in immunostained frozen sections compared with permanent paraffin sections and hematoxylin and eosin staining. METHODS We conducted a retrospective analysis of 38 LM cases treated by MMS between 2017 and 2020 in Melbourne, Australia. Immunostained frozen sections were assessed by a Mohs surgeon, whereas permanent paraffin sections were assessed by an external dermatopathologist. RESULTS We report 86% agreement in reporting of LM in immunostained frozen sections compared with permanent paraffin sections. In 5/38 cases, permanent paraffin sections were reported as clear for LM, but the Mohs surgeon had detected positive margins, requiring further excision. CONCLUSION For LM treated with MMS, there is a high agreement of clearance reporting between immunostained stained frozen sections and permanent paraffin sections without immunostaining; however, immunostained frozen sections may be more sensitive.

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Section: Discussionmentioning

confidence: 99%

Immunostained Frozen Sections Vs Traditional Permanent Paraffin Sections for Lentigo Maligna Treated With Mohs Micrographic Surgery

Punchihewa

Odhavji

Upjohn

et al. 2021

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“…Per our institutional protocol [5], she was treated with of-label imiquimod prior to Mohs surgery, three times weekly for 4 months, without perceptible improvement, though given the lack of pigmentation in this neoplasm, it was noted that response was challenging to assess. She subsequently underwent slow Mohs micrographic surgery with immunologic staining for Melan-A and Sox10, without residual melanoma being identifed [5][6][7][8]. Te defect was repaired linearly and healed well.…”

Section: Case Reportmentioning

confidence: 99%

Amelanotic Melanoma Treated as Fungal Infection for Years

Kuceki

Deacon

Secrest

2022

Case Reports in Dermatological Medicine

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This study describes a case of amelanotic lentigo maligna melanoma in a 69-year-old female that had been growing for approximately 5 years. The asymptomatic lesion had been previously diagnosed and treated as a fungal skin infection, an inflammatory rash, and an actinic keratosis that did not respond to standard treatments. Biopsy revealed confluent and nested atypical melanocytes at the dermal-epidermal junction, consistent with melanoma in situ. Excisional biopsy revealed invasive lentigo maligna melanoma, Breslow depth 0.3 mm, with positive melanoma in situ at margins. She is now 3 years post-Mohs surgery without recurrence. When working up a patient with a hypopigmented or inflammatory lesion not responding to standard therapies, physicians should always consider biopsy to rule out unusual neoplastic etiologies, such as amelanotic melanomas.

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“…13,22 A recent survey of Mohs surgeons and database analysis suggests wide-spread use of MART-1 in MMS for CM. 23,24 With techniques in MMS for treating melanocytic lesions evolving, there is an impetus to continue to evaluate emerging research for further clinical guideline development. To date, no systematic reviews have specifically examined the utilization of MART-1 staining in frozen sections for CMparticularly its effect on local recurrence.…”

Section: In-depth Review Melanoma Recurrence After Mohs Micrographic Surgery With Mart-1: a Systematic Review And Meta-analysismentioning

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

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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.

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The Current State of Mohs Surgery for the Treatment of Melanoma: A Nationwide Cross-Sectional Survey of Mohs Surgeons

Cited by 14 publications

References 20 publications

Immunostained Frozen Sections Vs Traditional Permanent Paraffin Sections for Lentigo Maligna Treated With Mohs Micrographic Surgery

Immunostained Frozen Sections Vs Traditional Permanent Paraffin Sections for Lentigo Maligna Treated With Mohs Micrographic Surgery

Amelanotic Melanoma Treated as Fungal Infection for Years

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

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