Benefit of Mohs Micrographic Surgery Over Wide Local Excision for Melanoma of the Head and Neck: A Rational Approach to Treatment

Addison M. Demer, Karl K. Vance, Nikoo Cheraghi, Hilary C. Reich, Peter K. Lee

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


BACKGROUND: There are limited published data comparing wide local excision (WLE) with Mohs micrographic surgery (MMS) for the treatment of melanoma.

OBJECTIVE: To describe a novel treatment algorithm for the surgical management of head and neck melanoma and compare rates of local recurrence for tumors treated with either MMS using immunohistochemistry or WLE.

MATERIALS AND METHODS: A 10-year retrospective chart review including all in situ and invasive melanomas of the head and neck treated at one institution from January 2004 to June 2013.

RESULTS: Among 388 patients with melanoma, MMS was associated with decreased rates of local recurrence (p = .0012). However, patient and tumor characteristics varied significantly, and WLE subgroup was largely composed of higher stage and risk tumors. Subgroup analysis found that patients with in situ or thin invasive tumors (<0.8 mm) treated with MMS had improved local recurrence outcomes (p = .0049), despite more frequent tumor location on high risk anatomic sites (e.g., central face). In addition, MMS was associated with a favorable delay in time to local recurrence among in situ tumors (HR = 31.8; p = .0148).

CONCLUSION: These findings further support the use of MMS for treatment of melanoma of the head and neck and help to validate our proposed clinical decision tree.

Original languageEnglish (US)
Pages (from-to)381-389
Number of pages9
JournalDermatologic Surgery
Issue number3
StatePublished - Mar 1 2019

Bibliographical note

Publisher Copyright:
© 2018 by the American Society for Dermatologic Surgery, Inc.


  • Aged
  • Algorithms
  • Decision Trees
  • Female
  • Head and Neck Neoplasms/pathology
  • Humans
  • Immunohistochemistry
  • Male
  • Margins of Excision
  • Melanoma/pathology
  • Middle Aged
  • Mohs Surgery
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local
  • Retrospective Studies
  • Risk Factors
  • Sentinel Lymph Node Biopsy
  • Skin Neoplasms/pathology

PubMed: MeSH publication types

  • Journal Article


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