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Mohs vs. Wide Local Excision for Early-Stage (AJCC 0-II) Cutaneous Head and Neck Melanoma: A Meta-Analysis
Anna Ardoin1, Srivatsa Surya Vasudevan2, Kashmira C Rodrigues2
1Louisiana State University Health School of Medicine, Shreveport, Louisiana, USA.
Objective:
To compare oncologic outcomes of Mohs micrographic surgery (MMS) versus wide local excision (WLE) in the management of cutaneous head and neck melanoma (CHNM), including melanoma in situ (MIS) and Stage I-II invasive disease.
Study Design:
Systematic review and meta-analysis.
Methods:
PubMed, Embase, ScienceDirect, and Web of Science were systematically searched for studies published between January 2000 and March 2026 that reported outcomes of MMS versus WLE for CHNM, including MIS and AJCC Stage I-II invasive disease. Outcomes of interest were recurrence, tumor upstaging, and secondary excision rates, which were pooled using a random-effects meta-analysis model. Sensitivity analyses were performed to assess robustness, and meta-regression was used to explore sources of heterogeneity.
Results:
Of 691 records screened, 23 studies comprising 7090 cases of early-stage (AJCC Stage 0-II) CHNM were included. The median age was 68.8 years, and 68.4% of patients were male. For MIS, the pooled local recurrence rate was lower after MMS (1.7%; 95% CI: 0.7-4.4) than after WLE (6.3%; 95% CI: 3.4-11.4). Upstaging to invasive melanoma was likewise less frequent with MMS (3.3%; 95% CI: 2.1-4.9) than with WLE (8.1%; 95% CI: 4.3-14.8), as was secondary surgical excision (1.2%; 95% CI: 0.1-10.3 vs. 9.7%; 95% CI: 3.0-27.0). Among Stage I-II cases, the pooled recurrence rate was 1.3% (95% CI: 0.3-4.6) after MMS and 8.8% (95% CI: 1.3-41.0) after WLE.
Conclusion:
Although none of the between-group differences reached statistical significance, MMS showed consistently favorable trends in local control and in reducing upstaging and secondary procedures for early-stage CHNM. These findings support consideration of MMS in appropriately selected patients.
