Head, neck melanomas more likely to need tissue-rearranging reconstruction vs. carcinomas

Tissue-rearranging reconstruction is needed more in melanomas of the head and neck, which have high local recurrence rates, compared with keratinocyte carcinomas, according to a study.

“National consensus guidelines recommend Mohs micrographic surgery (MMS) or comprehensive margin assessment with formalin-fixed, paraffin-embedded sections (slow Mohs) for keratinocyte carcinomas (KCs): basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) that have a high risk of local recurrence because of anatomic location on the head and neck, large size or recurrence after previous treatment,” William Fix, BA, of the Perelman School of Medicine at the University of Pennsylvania, and colleagues wrote. “In contrast, national guidelines for melanoma do not identify high local recurrence risk features, do not specify indications for MMS or slow Mohs, and do not comment on the timing of microscopic margin assessment relative to tissue-rearranging reconstruction.”

The retrospective cohort study included all head and neck melanomas, BCCs and invasive SCCs treated with MMS at the Hospital of the University of Pennsylvania between 2007 and 2017. KCs totaled 12,189 cases, with 8,743 being BCCs and 3,343 being SCCs; 103 cases had a collision with another tumor. Melanomas totaled 1,475 cases, with 1,065 being melanomas in situ and 410 being invasive melanomas.

The melanoma cases were significantly more likely to have features of high local recurrence risk, which included larger preoperative size (2.1 cm vs. 1.3 cm, P < .0001), recurrent status (5.08% vs. 3.91%, P = .031) and subclinical spread (31.73% vs. 26.52%, P < .0001).

Tissue reconstruction was required in 42% of melanomas (95% CI, 39.38%-44.65%) compared with 30.75% of KCs (95% CI, 29.21%-31.06%) (P < .0001).

“This study demonstrates that location on the head and neck, large size, recurrent status and tissue-rearranging reconstructions are factors that place melanomas at increased risk of complications from conventional excision, and future consensus guidelines for melanoma may consider these factors as indications for microscopic margin control with MMS or slow Mohs,” the authors wrote.