Improved overall survival of melanoma of the head and neck treated with Mohs micrographic surgery versus wide local excision - 07/11/19

Doi : 10.1016/j.jaad.2019.08.059

Jamie Hanson, MD ^a,^b,^⁎ , Addison Demer, MD ^a,^b, Walter Liszewski, MD ^a,^b, Neal Foman, MD, MS ^b, Ian Maher, MD ^b
^a Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
^b Department of Dermatology, University of Minnesota, Minneapolis, Minnesota

^∗Correspondence to: Jamie Hanson, MD, 516 Delaware St SE, Mail Code 98, Phillips-Wangensteen Bldg, Ste 4-240, Minneapolis, MN 55455.516 Delaware St SEMail Code 98Phillips-Wangensteen BldgSte 4-240MinneapolisMN55455

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Abstract

Background

Optimal surgical management for melanoma of the head and neck remains controversial.

Objective

Assess outcomes for melanomas of the head and neck treated with Mohs micrographic surgery (MMS) versus wide local excision (WLE) from the National Cancer Database.

Methods

Head and neck melanoma data from the National Cancer Database from years 2004-2015 were analyzed.

Results

In total, 50,397 cases of head and neck melanoma were reviewed; 3510 (7%) were treated with MMS and 46,887 (93%) with WLE. After controlling for potential confounding variables, patients treated with MMS were more likely than patients treated with WLE to survive after 5 years (hazard ratio [HR] 1.181, 95% confidence interval [CI] 1.083-1.288; P < .001). Factors associated with a statistically significant survival disadvantage included male sex (HR 1.287, 95% CI 1.242-1.357; P = 0), tumor ulceration (HR 1.687, 95% CI 1.616-1.760; P = 0), and positive surgical margins (HR 1.395, 95% CI 1.306-1.490; P = 0). Patient survival was inversely proportional to tumor Breslow depth.

Limitations

Database study, limited number of MMS treated melanomas.

Conclusion

MMS is a valid treatment option for melanoma of the head and neck; National Cancer Database data suggests that MMS might confer a survival benefit over WLE.

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Key words : melanoma, Mohs micrographic surgery, NCDB

Abbreviations used : CI, HR, MMS, NCDB, WLE