Mohs micrographic surgery versus wide local excision for head and neck melanoma-in-situ

Background: Various surgical options can be used to remove melanoma in situ (MIS). These include wide local excision (WLE), staged excision, and Mohs micrographic surgery (MMS). For MIS lesions located in the head and neck regions, the WLE approach may not always be a technically feasible option if both cosmesis and anatomical function is to be preserved.Methods: We performed a retrospective analysis of the Surveillance, Epidemiology, and End Results (SEERs) cancer registry. A total of 7933 cases of MIS in the head and neck region were included in this study, of which 5353 cases were treated by WLE and the remaining 2580 cases by MMS.Results: Comparing between the WLE and MMS group, cancer-specific survival rates at 5 (99% vs. 99%) and 10 years (98% vs. 98%) as well as the 5 year overall survival rate (85% vs. 86%) were similar. After adjusting for confounders, there was no significant difference in cancer-specific survival (HR: 0.902, 95% confidence interval (CI): 0.539-1.511, p = .695) and overall-survival (HR: 0.943, 0.813-1.093, p = .435).Conclusions: For cosmetic and functional purposes, MMS is a valid and suitable alternative to WLE to treat MIS due to its tissue-preserving nature particularly in the head and neck region.Key PointsOur adjusted analysis demonstrates similar overall and cancer-specific survival for Mohs surgery vs wide local excision for head and neck melanoma-in-situFor cosmetic and functional purposes, MMS is a valid and suitable alternative to WLE to treat MISThis is due to its tissue-preserving nature particularly in the head and neck region.