ABSTRACT
BACKGROUND: There are limited published data comparing wide local excision (WLE) with Mohs micrographic surgery (MMS) for the treatment of melanoma. OBJECTIVE: To describe a novel treatment algorithm for the surgical management of head and neck melanoma and compare rates of local recurrence for tumors treated with either MMS using immunohistochemistry or WLE. MATERIALS AND METHODS: A 10-year retrospective chart review including all in situ and invasive melanomas of the head and neck treated at one institution from January 2004 to June 2013. RESULTS: Among 388 patients with melanoma, MMS was associated with decreased rates of local recurrence (p = .0012). However, patient and tumor characteristics varied significantly, and WLE subgroup was largely composed of higher stage and risk tumors. Subgroup analysis found that patients with in situ or thin invasive tumors (<0.8 mm) treated with MMS had improved local recurrence outcomes (p = .0049), despite more frequent tumor location on high risk anatomic sites (e.g., central face). In addition, MMS was associated with a favorable delay in time to local recurrence among in situ tumors (HR = 31.8; p = .0148). CONCLUSION: These findings further support the use of MMS for treatment of melanoma of the head and neck and help to validate our proposed clinical decision tree.
Subject(s)
Decision Trees , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/surgery , Melanoma/pathology , Melanoma/surgery , Mohs Surgery , Skin Neoplasms/pathology , Skin Neoplasms/surgery , Aged , Algorithms , Female , Humans , Immunohistochemistry , Male , Margins of Excision , Middle Aged , Neoplasm Invasiveness , Neoplasm Recurrence, Local , Retrospective Studies , Risk Factors , Sentinel Lymph Node Biopsy , Melanoma, Cutaneous MalignantSubject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Squamous Cell/drug therapy , Immunosuppressive Agents/therapeutic use , Kidney Transplantation , Lymphoma, Large B-Cell, Diffuse/drug therapy , Neoplasms, Multiple Primary/drug therapy , Postoperative Complications/drug therapy , Sirolimus/therapeutic use , Skin Diseases/drug therapy , Skin Neoplasms/drug therapy , Warts/drug therapy , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Carcinoma, Squamous Cell/complications , Cyclophosphamide/therapeutic use , Doxorubicin/therapeutic use , Female , Humans , Lymphoma, Large B-Cell, Diffuse/complications , Middle Aged , Neoplasms, Multiple Primary/complications , Prednisone/therapeutic use , Remission Induction , Rituximab , Skin Diseases/complications , Skin Neoplasms/complications , Vincristine/therapeutic use , Warts/complicationsABSTRACT
Although Mohs micrographic surgery is the standard of care for large, aggressive or recurrent non-melanoma skin cancers of the head and neck, tumours that involve deep underlying structures (including bone, parotid gland and named nerves) are impractical for extirpation under local anaesthesia. Such cases are often referred to a head and neck surgeon, who typically relies on intraoperative frozen section analysis of the peripheral cutaneous margin. Here we describe the use of the Mohs moat technique as part of a collaborative approach for the treatment of aggressive and deeply invasive basal cell carcinoma that allows an analysis of the complete peripheral cutaneous margin and results in decreased operating room and general anaesthesia time.
