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Journal of the American Academy of Dermatology
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le jeudi 7 novembre 2019
Doi : 10.1016/j.jaad.2019.08.059
accepted : 22 August 2019
Improved overall survival of melanoma of the head and neck treated with Mohs micrographic surgery versus wide local excision
 

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
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.

The full text of this article is available in PDF format.

Key words : melanoma, Mohs micrographic surgery, NCDB

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



 Funding sources: None.
 Conflicts of interest: None disclosed.
 Reprints not available from the authors.



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