Mohs Surgery Shows Superior Outcomes in Hand, Foot Melanoma

Edited By: Deepa Varma

TOPLINE: 

Mohs micrographic surgery (MMS) outperforms conventional excision (CE) in patients with hand and foot melanomas, a retrospective cohort study finds. 

METHODOLOGY:

• Retrospective cohort study of 269 patients with hand and foot melanomas undergoing either CE (33.1%) or MMS (66.9%) at an academic center between 1994 and 2023.
• Hand location was defined as distal to the radiocarpal joint, and foot location was defined as distal to the talocrural joint.
• CE involved wide local excision or amputation evaluated with traditional vertical section permanent histology. MMS used same-day frozen section margins assessment by the Mohs surgeon with MART-1 immunostaining.
• The primary outcome was the rate of reconstruction with positive margins; secondary outcomes included repeat excisions and time to definitive reconstruction.

TAKEAWAY:

• Reconstruction with positive margins was more frequent after CE compared with MMS (20.2% vs 0; P < .001).
• CE showed higher rates of repeat excisions than MMS (20.2% vs 1.7%; P < .001).
• Patients who underwent CE reported longer time to definitive reconstruction compared with MMS (11.3 vs 1.4 days; P < .001).

IN PRACTICE:

“MMS reduces the risk of reconstruction with positive margins, repeat excisions, and time to definitive reconstruction of hand and foot melanoma,” the authors write.

SOURCE:

The study was led by Daniela Frankel, BS, University of Maryland School of Medicine, Baltimore. It was published online March 11 in the Journal of the American Academy of Dermatology.

LIMITATIONS: 

The study was limited by its single-site, retrospective design, which may affect the generalizability of the findings.

DISCLOSURES:

The study received support through the American Society for Dermatologic Surgery 2022 Jumpstart Research Seed Grant. The authors report no relevant financial relationships.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.