Highlights from the Literature Four
Outcomes of invasive melanoma of the head and neck treated with Mohs micrographic surgery - A multicenter study
By Arif Aslam, MBChB, FRACP, FACD
There are no randomized controlled trials to guide surgical management for head and neck invasive melanomas, so surgical margin recommendations have evolved from data taken from trunk and extremity sites. To address the gap in data for head and neck invasive melanoma treated with Mohs micrographic surgery (MMS) this retrospective multicenter study examined 785 cases of invasive head and neck melanomas using frozen sections with MART-1 over a 12-year period.
Of the 785 melanomas (thickness 0.3 mm-8.5 mm) treated with MMS, local recurrence, nodal recurrence and distant recurrence rates were 0.51% (4/785), 1.0% (8/785), and 1.1% (9/785) respectively. The five and ten-year disease specific survival was 96.8% (95% CI 95.0% to 98.5%) and 93.4% (95% CI 88.5% to 98.3%).
Whilst this study adds to the much needed data for MMS for invasive head and neck, it is worth noting the majority (81% [636]) of tumors were less than or equal to 1mm and this probably reflects the majority of our practice. The study did not differentiate between lentigo maligna and non-lentigo maligna melanoma subtypes, capture sentinel lymph node data, and clarify if local recurrence was melanoma in situ or invasive.