The following is a summary of “Outcomes of invasive melanoma of the head and neck treated with Mohs micrographic surgery – A multicenter study,” published in the SEPTEMBER 2023 issue of Dermatology by Beal, et al.

There was a lack of randomized controlled trials providing clear guidance on surgical margins for invasive head and neck (H&N) melanoma when using conventional excision methods. In contrast, Mohs micrographic surgery (MMS) has demonstrated promising results in reducing local recurrence rates and improving survival outcomes for invasive H&N melanomas. For a study, researchers sought to assess the rates of local recurrence (LR), nodal recurrence, and distant recurrence, as well as disease-specific survival, in cases of invasive H&N melanoma treated with MMS.

The retrospective multicenter study examined 785 cases of invasive H&N melanoma that underwent treatment with MMS. Frozen sections with melanoma antigen recognized by T-cells 1 immunohistochemical staining were employed to evaluate long-term outcomes over 12 years.

The findings indicated that out of the 785 melanomas (thickness: 0.3 mm-8.5 mm) treated with MMS, the LR rate was 0.51% (4/785), nodal recurrence rate was 1.0% (8/785), and distant recurrence rate was 1.1%(9/785). The LR rate for tumors classified as T1, T2, T3, and T4 was 0.16% (1/636), 1.18% (1/85), 2.22% (1/45), and 5.26% (1/19), respectively. The 5-year and 10-year disease-specific survival rates were 96.8% (95% CI 95.0% to 98.5%) and 93.4% (95% CI 88.5% to 98.3%), respectively.

Although the study had limitations, being a nonrandomized retrospective study, its results suggested that MMS leads to significant reductions in LR compared to historical cohorts of patients treated with conventional excision methods. Consequently, MMS should be considered an important surgical option for managing invasive H&N melanoma cases.

Source: jaad.org/article/S0190-9622(23)00062-2/fulltext