title: Outcomes of Melanoma In Situ Treated With Mohs Micrographic Surgery Compared With Wide Local Excision.
abstract: Melanoma in situ (MIS) is increasing in incidence, and expert consensus opinion recommends surgical excision for therapeutic management. Currently, wide local excision (WLE) is the standard of care. However, Mohs micrographic surgery (MMS) is now used to treat a growing subset of individuals with MIS. During MMS, unlike WLE, the entire cutaneous surgical margin is evaluated intraoperatively for tumor cells.
  
  
  
  To assess the outcomes of patients with MIS treated with MMS compared with those treated with WLE.
  
  
  
  Retrospective review of a prospective database. The study cohort consisted of 662 patients with MIS treated with MMS or WLE per standard of care in dermatology and surgery (general surgery, otolaryngology, plastics, oculoplastics, surgical oncology) at an academic tertiary care referral center from January 1, 1978, to December 31, 2013, with follow-up through 2015.
  
  
  
  Mohs micrographic surgery or WLE.
  
  
  
  Recurrence, overall survival, and melanoma-specific survival.
  
  
  
  There were 277 patients treated with MMS (mean [SD] age, 64.0 [13.1] years; 62.1% male) and 385 treated with WLE (mean [SD] age, 58.5 [15.6] years; P < .001 for age; 54.8% male). Median follow-up was 8.6 (range, 0.2-37) years. Compared with WLE, MMS was used more frequently on the face (222 [80.2%] vs 141 [36.7%]) and scalp and neck (23 [8.3%] vs 26 [6.8%]; P < .001). The median (range) year of diagnosis was 2008 (1986-2013) for the MMS group vs 2003 (1978-2013) for the WLE group (P < .001). Overall recurrence rates were 5 (1.8%) in the MMS group and 22 (5.7%) in the WLE group (P = .07). Mean (SD) time to recurrence after MMS was 3.91 (4.4) years, and after WLE, 4.45 (2.7) years (P = .73). The 5-year recurrence rate was 1.1% in the MMS group and 4.1% in the WLE group (P = .07). For WLE-treated tumors, the surgical margin taken was greater for tumors that recurred compared with tumors that did not recur (P = .003). Five-year overall survival for MMS was 92% and for WLE was 94% (P = .28). Melanoma-specific mortality for the MMS group was 2 vs 13 patients for the WLE group, with mean (SD) survival of 6.5 (4.8) and 6.1 (0.8) years, respectively (P = .77).
  
  
  
  No significant differences were found in the recurrence rate, overall survival, or melanoma-specific survival of patients with MIS treated with MMS compared with WLE.
authors.affiliation: Department of Dermatology, University of California, San Francisco2Dermatology Service, Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Adi
authors.initials: A
authors.lastname: Nosrati
authors.affiliation: Department of Dermatology, University of California, San Francisco2Dermatology Service, Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Jacqueline G
authors.initials: JG
authors.lastname: Berliner
authors.affiliation: Dermatology Service, Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Goel
authors.affiliation: Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco.
authors.forename: Joseph
authors.initials: J
authors.lastname: McGuire
authors.affiliation: Dermatology Service, Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Vera
authors.initials: V
authors.lastname: Morhenn
authors.affiliation: Department of Dermatology, University of California, San Francisco.
authors.forename: Juliana R
authors.initials: JR
authors.lastname: de Souza
authors.affiliation: Department of Dermatology, University of California, San Francisco.
authors.forename: Yildiray
authors.initials: Y
authors.lastname: Yeniay
authors.affiliation: Department of Dermatology, University of California, San Francisco.
authors.forename: Rasnik
authors.initials: R
authors.lastname: Singh
authors.affiliation: Department of Dermatology, University of California, San Francisco.
authors.forename: Kristina
authors.initials: K
authors.lastname: Lee
authors.affiliation: Department of Dermatology, University of California, San Francisco.
authors.forename: Mio
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Dermatology Service, Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Wu
authors.affiliation: Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco.
authors.forename: Ann
authors.initials: A
authors.lastname: Griffin
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco.
authors.forename: Barbara
authors.initials: B
authors.lastname: Grimes
authors.affiliation: Department of Dermatology, University of California, San Francisco.
authors.forename: Eleni
authors.initials: E
authors.lastname: Linos
authors.affiliation: Department of Dermatology, University of California, San Francisco2Dermatology Service, Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Mary Margaret
authors.initials: MM
authors.lastname: Chren
authors.affiliation: Department of Dermatology, University of California, San Francisco.
authors.forename: Roy
authors.initials: R
authors.lastname: Grekin
authors.affiliation: Department of Dermatology, University of California, San Francisco2Dermatology Service, Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Wei
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D015580:Mohs Surgery / Q000379:methods*; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome