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Mohs surgery offers greater survival benefit vs. wide local excision in head and neck melanoma

Melanomas of the head and neck treated with Mohs micrographic surgery had a significantly higher overall survival at 5 years after melanoma diagnosis than those treated with wide local excision, according to 2004 to 2015 data from the National Cancer Database.

“Interestingly, a higher percentage of [Mohs micrographic surgery] for melanoma was performed at an academic institution than those treated by [wide local excision] (73.19% vs. 49.27%) and on multivariate analysis, treatment at an academic institution over any other facility type was associated with improved survival,” Jamie Hanson, MD, of the department of dermatology at Minneapolis VA Medical Center, and colleagues wrote.

A total of 50,397 head and neck melanomas met inclusion criteria, of which 7% of melanomas (n = 3,510) were treated with Mohs micrographic surgery (MMS) and 93% (n = 46,887) were treated with wide local excision (WLE).

Most patients were white (98.2%), men (74.1%), with a mean age of 68.7 years, and treatment groups did not vary significantly.

A higher percentage of patients in the MMS group were treated at an academic institution than in the WLE group, 73.79% vs. 49.27%, respectively. Overall, the Breslow depth was thinner in MMS-treated tumors (0.8 mm) vs. tumors with WLE (1.7 mm).

Researchers found a statistically significant higher overall survival at 5 years after melanoma diagnosis than those treated with WLE (HR = 1.181; 95% CI, 1.083-1.288).

The following factors were associated with a statistically significant survival disadvantage: age, male sex, nonprivate insurance, tumor ulceration, positive surgical margins, a higher Charlson-Deyo comorbidity score and nodular histologic subtype, according to researchers.

Furthermore, when evaluating tumors by Breslow depth, melanomas of the head and neck treated with MMS had no significant survival disadvantage at any given T-score than those treated with WLE.

Invasive melanomas with a Breslow depth of 0.01 mm to 0.74 mm had a statistically significant survival advantage when treated with MMS vs. WLE, which was valid on both univariate (HR = 1.29; 95% CI, 1.14-1.47) and multivariate analysis (HR = 1.164; 95% CI, 1.03-1.32), according to researchers.

“While recent guidelines have deemphasized MMS and margin-controlled surgeries as a treatment modality for head and neck melanoma, the weight of retrospective evidence suggesting a significant benefit with regard to minimizing local recurrence, preserving vital anatomic structures and the findings from multiple database and population studies demonstrating no survival disadvantage all support the notion that MMS and complete margin examination surgeries should be considered for the treatment of melanomas of the head and neck,” Hanson and colleagues wrote. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.