Analyzing the Value and Controversy of MMS for Melanoma and MIS on the Trunk and Extremities

The following is a summary of “Controversy and Value of Mohs Micrographic Surgery for Melanoma and Melanoma in Situ on the Trunk and Extremities,” published in the November 2023  issue of Dermatology by Zitelli, et al.

The use of Mohs surgery for the treatment of melanoma on the trunk and extremities is not endorsed by the standards of dermatology, yet it is commonly used in the real world. For a study, researchers sought to bring the usefulness of Mohs surgery for melanoma on the trunk and extremities to those considering revising the recommendations.

This was a retrospective assessment of a database that was kept prospectively to identify individuals whose melanomas would have likely recurred if conventional surgical margins had been used. A prediction model was used to determine the worth of Mohs surgery. The model projected that 2,847 people with melanoma on the trunk and extremities would likely return each year with conventional surgical margins even after re-excision when positive margins were discovered. This contrasts with the 0.1% of patients who would have recurrence following Mohs surgery. 

On account of this, it is quite probable that 27% of patients with melanoma in situ and 13% of patients with invasive melanoma would be elevated to a higher stage. Melanoma-specific survival would also decline as a consequence of the upstaging, and one percent of patients who had actual local recurrences of melanoma would pass away as a consequence of the upstaging. When it comes to melanoma on the trunk and extremities, Mohs surgery is beneficial because it reduces the risk of local recurrence and mortality due to the advancement of the illness.


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