TY - JOUR
T1 - Current perspectives on Mohs micrographic surgery for melanoma
AU - Beaulieu, Derek
AU - Fathi, Ramin
AU - Srivastava, Divya
AU - Nijhawan, Rajiv I
N1 - Publisher Copyright:
© 2018 Beaulieu et al.
PY - 2018/5/30
Y1 - 2018/5/30
N2 - Mohs micrographic surgery (MMS), a specialized surgical excision technique used primarily in the treatment of skin cancers, is tissue sparing and provides optimal margin control through evaluation of 100% of both the peripheral and deep margin. The use of MMS for the treatment of malignant melanoma (MM) and melanoma in situ (MIS) has been slow in gaining the same widespread acceptance that it has for keratinocyte carcinomas despite its cost-effectiveness and the growing body of evidence demonstrating similar or improved cure rates to standard wide local excision. However, modern advances in immunohistochemical staining have continued to greatly enhance the ability of Mohs surgeons to interpret MMS frozen sections of melanoma specimens – the primary concern of most opponents of MMS for melanoma. These advances, coupled with an increased recognition by professional organizations of the utility of MMS in treating MM and MIS, have led to a rise in the use of MMS for melanoma in recent years. Given the expanding role of MMS in the treatment of cutaneous melanoma, this manuscript will describe how MMS is performed, discuss the rationale and current evidence regarding the use of MMS for MM and MIS, review the immunohistochemical stains currently available for use in MMS, and consider special situations and future directions in this area of growing interest.
AB - Mohs micrographic surgery (MMS), a specialized surgical excision technique used primarily in the treatment of skin cancers, is tissue sparing and provides optimal margin control through evaluation of 100% of both the peripheral and deep margin. The use of MMS for the treatment of malignant melanoma (MM) and melanoma in situ (MIS) has been slow in gaining the same widespread acceptance that it has for keratinocyte carcinomas despite its cost-effectiveness and the growing body of evidence demonstrating similar or improved cure rates to standard wide local excision. However, modern advances in immunohistochemical staining have continued to greatly enhance the ability of Mohs surgeons to interpret MMS frozen sections of melanoma specimens – the primary concern of most opponents of MMS for melanoma. These advances, coupled with an increased recognition by professional organizations of the utility of MMS in treating MM and MIS, have led to a rise in the use of MMS for melanoma in recent years. Given the expanding role of MMS in the treatment of cutaneous melanoma, this manuscript will describe how MMS is performed, discuss the rationale and current evidence regarding the use of MMS for MM and MIS, review the immunohistochemical stains currently available for use in MMS, and consider special situations and future directions in this area of growing interest.
KW - Evidence
KW - Immunohistochemical stains
KW - Melanoma
KW - Melanoma in situ
KW - Mohs micrographic surgery
KW - Review
UR - http://www.scopus.com/inward/record.url?scp=85057085462&partnerID=8YFLogxK
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U2 - 10.2147/CCID.S137513
DO - 10.2147/CCID.S137513
M3 - Review article
C2 - 29950878
AN - SCOPUS:85057085462
SN - 1178-7015
VL - 11
SP - 309
EP - 320
JO - Clinical, Cosmetic and Investigational Dermatology
JF - Clinical, Cosmetic and Investigational Dermatology
ER -