title: Correlation Between Appropriate Use Criteria and the Frequency of Subclinical Spread or Reconstruction With a Flap or Graft for Melanomas Treated With Mohs Surgery With Melanoma Antigen Recognized by T Cells 1 Immunostaining.
abstract: BACKGROUND
  Published appropriate use criteria (AUC) for Mohs micrographic surgery (MMS) for melanoma are based on consensus opinion.
  
  
  OBJECTIVE
  To evaluate whether published AUC identify melanomas for which MMS may benefit patients by detecting subclinical spread or confirming clear microscopic margins before flap or graft reconstruction.
  
  
  METHODS
  Retrospective cohort study of 591 melanomas in 556 patients evaluating the correlation between current AUC (anatomic location, recurrent status, and tumor stage) and subclinical spread or reconstruction with a flap or graft.
  
  
  RESULTS
  Anatomic location on the head, neck, genitalia, hands, feet, or pretibial leg was associated with a significantly higher frequency of subclinical spread (odds ratio (OR) 1.89, p = .0280) and flap or graft reconstruction (OR 10.3, p = .0001). Compared with primary lesions, recurrent melanomas had a higher frequency of subclinical spread (OR 1.78, p = .0104) and reconstruction with a flap or graft (OR 1.67, p = .0217). The frequencies of subclinical spread and flap or graft reconstruction did not differ between in situ and invasive melanomas.
  
  
  CONCLUSIONS
  Anatomic location and recurrent status are useful criteria to identify melanomas that may benefit from MMS. Tumor stage is not a useful criterion, as MMS has similar benefits for subsets of both invasive and in situ melanomas.
authors.affiliation: Departments of *Dermatology, †Otorhinolaryngology, and ‡Pediatrics, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Etzkorn
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Sobanko
authors.forename: Thuzar M
authors.initials: TM
authors.lastname: Shin
authors.forename: Rosalie
authors.initials: R
authors.lastname: Elenitsas
authors.forename: Emily Y
authors.initials: EY
authors.lastname: Chu
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gelfand
authors.forename: David J
authors.initials: DJ
authors.lastname: Margolis
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newman
authors.forename: Hayley
authors.initials: H
authors.lastname: Goldbach
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Miller
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D058965:MART-1 Antigen / Q000032:analysis; D008297:Male; D008545:Melanoma / Q000276:immunology / Q000473:pathology* / Q000601:surgery*; D015580:Mohs Surgery; D009367:Neoplasm Staging; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000276:immunology / Q000473:pathology* / Q000601:surgery*; D016038:Skin Transplantation; D013194:Staining and Labeling; D013524:Surgical Flaps / Q000706:statistics & numerical data
chemical_list: D058965:MART-1 Antigen