Survival after Mohs surgery for invasive melanoma associated with treatment facility

Early-stage invasive melanoma excised with Mohs micrographic surgery at academic and top decile-volume facilities was associated with improved long-term survival, according to a study published in JAMA Dermatology.

“Mohs micrographic surgery (MMS) offers the advantage of complete margin evaluation during the procedure while potentially limiting healthy tissue removal. ... Recent work suggests that treatment of early-stage (T1a-T2a category) melanoma with MMS is associated with a modest survival advantage compared with traditional wide local excision,” Shayan Cheraghlou, MD, of the department of dermatology, Yale School of Medicine, and colleagues wrote. “Although studies of resections for other cancers have reported that facility-level factors are associated with patient outcomes, it is not yet established how such factors may affect outcomes for patients treated with MMS for invasive melanoma.”

In the retrospective cohort study, researchers analyzed 4,062 patients (median age 60 years, 54.5% men) diagnosed with nonmetastatic T1a-T2a melanoma treated with MMS from the National Cancer Database to evaluate the association of treatment center academic affiliation with long-term survival. Researchers further used multivariable survival analyses and Cox proportional hazards models for association assessment.

Of 462 treatment centers, 27.5% were academic institutions treating 56.8% of study patients and 13.4% were top decile-volume facilities treating 61.9% of study patients.

Multivariable analysis showed treatment at an academic center was associated with a 30% reduction in death (HR = 0.730; 95% CI, 0.596-0.895). Further analysis revealed treatment at a top decile-volume facility was also associated with a reduced risk of death (HR = 0.795; 95% CI, 0.648-0.977).

“Facility case volume and academic affiliation are significantly associated with long-term survival after MMS for T1a-T2a invasive melanoma,” Cheraghlou and colleagues wrote. “Further study of the underlying reasons for these differences in survival, as well as the development of consensus standards for the technique, may help to reduce such variations in patient outcomes across treatment centers.”