title: The use of Mohs micrographic surgery (MMS) for melanoma in situ (MIS) of the trunk and proximal extremities.
abstract: BACKGROUND
  Evaluation of the entire surgical margin results in high rates of complete excision, low local recurrence rates, and maximal tissue conservation. Although well recognized for melanoma of the head and neck, few studies have focused exclusively on the trunk and proximal extremities.
  
  
  OBJECTIVE
  We sought to evaluate the efficacy of Mohs micrographic surgery for melanoma in situ (MIS) of the trunk and proximal extremities, and determine adequate excision margins for MIS when total margin evaluation is not used.
  
  
  METHODS
  Long-term outcomes in 882 cases of MIS treated with Mohs micrographic surgery were analyzed and compared with historical controls. Rates of complete excision were determined for increasing surgical margin intervals.
  
  
  RESULTS
  One local recurrence occurred in our cohort (0.1%). Only 83% of MIS were excised with a 6-mm margin. Margins of 9 mm were needed to excise 97% of MIS, statistically equivalent to thin melanomas.
  
  
  CONCLUSIONS
  We used a nonrandomized, single-institution, retrospective design.
  
  
  CONCLUSIONS
  Mohs micrographic surgery may cure the 17% of MIS that exceed traditional excision margins of 5 mm and is a valuable option for these patients. Surgical margins of at least 0.9 cm should be considered for MIS of the trunk and extremities when total margin evaluation is not used.
authors.affiliation: Zitelli and Brodland PC, University of Pittsburgh Medical Center-Shadyside, Pittsburgh, Pennsylvania. Electronic address: lstigall@gmail.com.
authors.forename: Landon E
authors.initials: LE
authors.lastname: Stigall
authors.affiliation: Zitelli and Brodland PC, University of Pittsburgh Medical Center-Shadyside, Pittsburgh, Pennsylvania.
authors.forename: David G
authors.initials: DG
authors.lastname: Brodland
authors.affiliation: Zitelli and Brodland PC, University of Pittsburgh Medical Center-Shadyside, Pittsburgh, Pennsylvania.
authors.forename: John A
authors.initials: JA
authors.lastname: Zitelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D065426:Cytoreduction Surgical Procedures; D005121:Extremities; D005260:Female; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000473:pathology / Q000601:surgery*; D008297:Male; D000072662:Margins of Excision; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D015580:Mohs Surgery; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D060726:Torso; D016896:Treatment Outcome; D055815:Young Adult; D000096142:Cutaneous Malignant Melanoma
keywords: Mohs micrographic surgery; excision margins; guidelines; melanoma; melanoma in situ; surgery; surgical margins