Concordance Between a Mohs Micrographic Surgeon and Dermatopathologist on Margin Status for Melanoma In Situ and the...

Few studies have examined the concordance between Mohs surgeons and dermatopathologists' interpretation of margin status during Mohs micrographic surgery (MMS) for melanoma in situ (MIS).

The objectives of this study were to determine the concordance between a Mohs surgeon and dermatopathologist on margin status for MIS and to analyze the role of immunohistochemical stains during Mohs surgery.

This was a prospective study at 1 academic center of patients undergoing Mohs surgery for MIS. The Mohs surgeon and dermatopathologist independently examined the margins and completed surveys on the usefulness of H&E and immunohistochemical stains in each case. Six-year follow-up data on tumor recurrence and metastasis were collected.

The surgeon and dermatopathologist agreed on margin status in 95% of cases (95% confidence interval: 0.84-0.99). The dermatopathologist found H&E alone to be the most useful stain for the first stage of MMS, while the Mohs surgeon found the combination of H&E and SOX10 most useful. This study is limited by the use of only 2 physicians.

There was a high concordance between the Mohs surgeon and dermatopathologist on MIS margin status. Immunohistochemical stains were more useful for the Mohs surgeon.