Outcomes of invasive melanoma of the head and neck treated with Mohs micrographic surgery – A multicenter study

• Published in: Journal of the American Academy of Dermatology Vol. 89; no. 3; pp. 544 - 550
• Main Authors: Beal, Brandon T., Udkoff, Jeremy, Aizman, Leora, Etzkorn, Jeremy, Zitelli, John A., Miller, Christopher J., Shin, Thuzar M., Sobanko, Joseph F., Brodland, David G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2023
• Subjects: head and neck; head and neck invasive melanoma; head and neck melanoma; Humans; invasive melanoma; melanoma; Melanoma - pathology; melanoma outcomes; Melanoma, Cutaneous Malignant; Mohs microscopic surgery; Mohs Surgery; multicenter; Multicenter Studies as Topic; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - surgery; Retrospective Studies; Skin Neoplasms - pathology; Treatment Outcome; Mohs microscopic surgery; NCCN; NR; LR; head and neck invasive melanoma; DR; DSD; AJCC; head and neck melanoma; head and neck; melanoma outcomes; CE; DSR; OS; DSS; MART-1; ZB; melanoma; SLNB; ICH; Penn; H&N; MMS; invasive melanoma; RCTs; multicenter; Mohs surgery
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2022.12.038

There are no randomized controlled trials to guide surgical margins for invasive head and neck (H&N) melanoma using conventional excision. Mohs micrographic surgery (MMS) has shown improved local recurrence rates and survival for invasive H&N melanomas.
Determine local recurrence (LR), nodal recurrence, and distant recurrence rates, and disease specific survival for invasive melanoma of the H&N treated with MMS.
A retrospective multicenter study of 785 cases of invasive H&N melanoma treated with MMS using frozen sections with melanoma antigen recognized by T-cells 1 immunohistochemical staining was performed to evaluate long-term outcomes over 12-years.
785 melanomas (thickness: 0.3 mm-8.5 mm) were treated with MMS. LR, nodal recurrence, and distant recurrence rates were 0.51% (4/785), 1.0% (8/785), and 1.1% (9/785) respectively. For T1, T2, T3, and T4 tumors LR was 0.16% (1/636), 1.18% (1/85), 2.22% (1/45), and 5.26% (1/19), respectively. Five and 10-year disease specific survival were 96.8% (95% CI 95.0% to 98.5%) and 93.4% (95% CI 88.5% to 98.3%).
A nonrandomized retrospective study.
MMS achieves significant improvements in LR compared to a meta-analysis of historical cohorts of patients treated with conventional excision. MMS should be considered an important surgical option for invasive H&N melanoma.