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Mohs Micrographic Surgery for Melanoma: A Convincing Treatment Modality
Stephanie Clements1, Amor Khachemoune2,3
1Department of Dermatology, University of Maryland Medical Center, Baltimore, MD, USA.
Indian Journal of Dermatology
|December 29, 2022
Summary
Mohs micrographic surgery (MMS) is recommended for thin melanomas and invasive melanomas in critical areas. Intraoperative MART-1 immunostains aid in MMS melanoma treatment, with MITF and SOX10 as useful adjuncts.
Area of Science:
- Dermatology
- Surgical Oncology
Background:
- Mohs micrographic surgery (MMS) is the standard for keratinocyte carcinomas.
- Its application in invasive melanoma with intraoperative immunostains remains debated.
Purpose of the Study:
- To review literature and provide recommendations for MMS in melanoma treatment.
- To define specific scenarios where MMS is advantageous for melanoma.
Main Methods:
- Literature review supporting recommendations for MMS in melanoma treatment.
- Analysis of tumor characteristics, location, and histologic subtypes.
Main Results:
- MMS is recommended for thin melanomas (<0.8 mm Breslow depth) in cosmetically/functionally sensitive areas.
- MMS is advised for lentigo maligna melanoma (LMM) and superficial spreading melanoma on the head and neck <0.8 mm Breslow depth.
- Melanoma antigen recognized by T cells 1 (MART-1) immunostain is recommended intraoperatively.
Conclusions:
- MMS offers high cure rates and tissue preservation for select melanoma cases.
- Intraoperative MART-1 immunostains enhance MMS accuracy for melanoma.
- MITF and SOX10 immunostains can assist in challenging melanoma cases.
