title: Mohs Micrographic Surgery Using MART-1 Immunostain in the Treatment of Invasive Melanoma and Melanoma In Situ.
abstract: BACKGROUND
  Mohs micrographic surgery (MMS) with melanoma antigen recognized by T-cell (MART-1) immunostaining is an effective treatment of cutaneous melanoma.
  
  
  OBJECTIVE
  To determine the efficacy of MMS with MART-1 immunostain in the management of invasive and in situ melanoma.
  
  
  METHODS
  A retrospective cohort study evaluated 2,114 melanomas in 1,982 patients excised using MMS and MART-1 immunostain. The margins required for excision were calculated based on Breslow thickness, location, and size. Survival and local recurrence rates were calculated and compared with those of historical controls.
  
  
  RESULTS
  The mean follow-up period was 3.73 years. Local recurrence was identified in 0.49% (7/1,419) of primary melanomas. Approximately 82% of melanomas were excised with ≤6-mm margins. The surgical margin was significantly related to tumor location and size but not to Breslow thickness. The five-year Kaplan-Meier local recurrence and disease-specific survival rates were 0.59 ± 0.30 and 98.53 ± 0.42, respectively. Mohs micrographic surgery with MART-1 immunostain achieved lower local recurrence rates and equivalent or higher Kaplan-Meier survival rates than conventional wide local excision.
  
  
  CONCLUSIONS
  Mohs micrographic surgery with MART-1 immunostain is an effective treatment of melanoma as evidenced by low local recurrence rates. It offers the advantage of more tissue-conserving margins than those recommended for conventional excision.
authors.affiliation: *Department of Dermatology, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico; †Departments of Plastic Surgery, Dermatology, and Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; ‡Zitelli and Brodland Skin Cancer Center, Pittsburgh, Pennsylvania; §Puerto Rico Clinical and Translational Research Consortium, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico; ‖Biostatistics and Epidemiology Department, Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Valentín-Nogueras
authors.forename: David G
authors.initials: DG
authors.lastname: Brodland
authors.forename: John A
authors.initials: JA
authors.lastname: Zitelli
authors.forename: Lorena
authors.initials: L
authors.lastname: González-Sepúlveda
authors.forename: Cruz M
authors.initials: CM
authors.lastname: Nazario
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D058965:MART-1 Antigen / Q000276:immunology*; D008297:Male; D008545:Melanoma / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D015580:Mohs Surgery; D009361:Neoplasm Invasiveness / Q000473:pathology; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D058965:MART-1 Antigen