Mohs micrographic surgery for melanoma: A prospective multicenter study - 15/08/19
, John A. Zitelli, MD b, David G. Brodland, MD bAbstract |
Background |
Single-institution studies show that frozen section Mohs micrographic surgery (MMS) is an effective treatment modality for cutaneous melanoma, but no multi-institutional studies have been published.
Objective |
To characterize the use of MMS in the treatment of melanoma at 3 academic and 8 private practices throughout the United States, to recommend excision margins when 100% histologic margin evaluation is not used, and to compare actual costs of tumor removal with MMS vs standard surgical excision.
Methods |
Prospective, multicenter, cohort study of 562 melanomas treated with MMS with melanoma antigen recognized by T cells 1 immunostaining.
Results |
Primary trunk and extremity melanomas (noninvasive and invasive melanoma) achieved histologically negative margins in 97% of tumors with 10-mm margins, whereas 12-mm margins were necessary to achieve histologically negative margins in 97% of head and neck melanomas. Overall average cost per tumor treated was $1328.46.
Limitations |
Nonrandomized and noncontrolled study.
Conclusions |
MMS with melanoma antigen recognized by T cells 1 immunostaining safely provides tissue conservation and same-day reconstruction of histologically verified tumor-free margins in a convenient, single-day procedure. When comprehensive margin evaluation is not used, initial surgical margins of at least 10 mm for primary trunk/extremity and 12 mm for head/neck melanomas should be used to achieve histologically negative margins 97% of the time.
Le texte complet de cet article est disponible en PDF.Key words : excision margins, guidelines, lentigo maligna, MART-1, melanoma in situ, melanoma, Mohs micrographic surgery, prospective multicenter, surgery, surgical
Abbreviations used : IM, LM, MART-1, MIS, MMS, NIM, SSE
Plan
| Funding sources: 2012 American Society for Dermatologic Surgery Cutting Edge Research Grant ($5000). |
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| Conflicts of interest: None disclosed. |
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| The preliminary data were presented as a poster at the 2016 American College of Mohs Surgery on April 28, 2016 and as a brief presentation at the American Society for Dermatologic Surgery on November 6, 2014. |
Vol 81 - N° 3
P. 767-774 - septembre 2019 Retour au numéro
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