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Review
. 2018 Jun 20:11:309-320.
doi: 10.2147/CCID.S137513. eCollection 2018.

Current perspectives on Mohs micrographic surgery for melanoma

Derek Beaulieu  1 , Ramin Fathi  2 , Divya Srivastava  2 , Rajiv I Nijhawan  2
Affiliations
Review

Current perspectives on Mohs micrographic surgery for melanoma

Derek Beaulieu et al. Clin Cosmet Investig Dermatol. .

Abstract

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.

Keywords: Mohs micrographic surgery; evidence; immunohistochemical stains; melanoma; melanoma in situ; review.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Schematic of Mohs micrographic surgical excision for melanoma. (A) Clinical view (B) Cross-sectional view.
Figure 2
Figure 2
Pre-operative photograph of an MIS of the face outlining the clinical margins examined with a Wood’s lamp (inner marking) and Mohs excisional specimen (outer marking).
Figure 3
Figure 3
Photomicrographs of positive margins on MART-1 immunostain (left) versus H&E-stained (right) frozen sections displaying how MART-1 improves interpretability of MMS frozen sections for melanoma.
See this image and copyright information in PMC

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