Mohs surgery lessens recurrence, improves survival rates in head and neck melanoma
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Mohs micrographic surgery decreased recurrence rates and increased survival among patients with head and neck melanoma compared with conventional excision, according to a study.
“There are no randomized controlled trials to guide surgical margins for invasive head and neck melanoma using conventional excision,” Brandon T. Beal , MD, FAAD, Mohs micrographic surgeon and cosmetic dermatologist at St. Louis Skin Cancer Specialists in Troy, Missouri, told Healio. “All the melanoma randomized controlled trials intentionally excluded invasive head and neck melanoma. ... Thus, we have limited randomized controlled trial data to guide margins for invasive melanoma of the head and neck, and so these melanomas have worse outcomes than trunk and extremity melanomas.”
In this retrospective, multicenter study, researchers evaluated the long-term outcomes of 785 head and neck melanoma cases treated with Mohs micrographic surgery (MMS) using frozen sections with MART-1 immunohistochemical staining. Outcomes were evaluated over a 12-year span and include local, nodal and distance recurrence rates, as well as disease-specific survival.
The mean age of the patients was 69.4 years and 71% were men. Of the 785 tumors, 81% had a Breslow thickness of 1 mm or smaller and 10.8% measured between 1.01 mm and 2 mm. Tumors ranged from 0.3 mm to 8.5 mm in thickness.
Results showed an overall local recurrence rate of 0.51%, a nodal recurrence of 1% and a distant recurrence of 1.1%. Additionally, the local recurrence rate was 0.16% for T1 tumors, 1.18% for T2 tumors, 2.22% for T3 tumors and 5.26% for T4 tumors.
Overall melanoma-specific death was 2.4% with disease-specific survival of 96.8% for 5 years and 93.4% for 10 years.
The researchers further found Breslow depth to be connected to melanoma-specific death, with those who survived having a median 0.79 mm tumor thickness and those who died from melanoma having a median 2.21 mm tumor thickness (P < .001). Tumor location was also a factor, with tumors on the head vs. other sites associated with greater melanoma-specific mortality (P = .009).
The study was limited being non-randomized and retrospective, according to the researchers.
“This study, as well as others, demonstrates the clinical value of Mohs surgery for invasive melanoma of the head and neck,” Beal said. “The MMS technique is the most comprehensive assessment of a surgical margin, both peripheral and deep, ensuring the best outcome for patients with invasive melanoma of the head and neck.”