Outcomes of invasive melanoma of the head and neck treated with Mohs Micrographic Surgery – a multicenter study

Background: There are no randomized controlled trials to guide surgical margins for invasive head and neck (H&N) melanoma using conventional excision (CE). Mohs Micrographic Surgery (MMS) has shown improved local recurrence rates and survival for invasive H&N melanomas. Objective: Determine local, nodal, and distant recurrence rates (LR, NR, DR respectively), and disease-specific survival (DSS) for invasive melanoma of the head and neck treated with MMS. Methods: A retrospective multicenter study of 785 cases of invasive H&N melanoma treated with MMS using frozen sections with MART-1 immunohistochemical staining was performed to evaluate long-term outcomes over 12-years. Results: 785 melanomas (thickness 0.3mm-8.5mm) were treated with MMS. LR, NR, and DR rates were 0.51% (4/785), 1.0% (8/785), and 1.1% (9/785) respectively. For T1, T2, T3 and T4 tumors LR was 0.16% (1/636), 1.18% (1/85), 2.22% (1/45), and 5.26% (1/19), respectively. Five and 10-year DSS were 96.8% (95%CI 95.0%-98.5%) and 93.4% (95%CI 88.5%-98.3%). Limitations: A non-randomized retrospective study. Conclusion: MMS achieves significant improvements in local recurrence compared to a meta-analysis of historical cohorts of patients treated with CE. MMS should be considered an important surgical option for invasive head and neck melanoma.

研究背景：目前尚无随机对照试验可指导侵袭性头颈部（head and neck, H&N）黑色素瘤采用常规切除术（conventional excision, CE）的手术切缘制定。莫氏显微外科手术（Mohs Micrographic Surgery, MMS）已被证实可改善侵袭性头颈部黑色素瘤的局部复发率与生存率。
研究目的：明确接受莫氏显微外科手术治疗的头颈部侵袭性黑色素瘤患者的局部复发率（local recurrence, LR）、区域淋巴结复发率（nodal recurrence, NR）及远处复发率（distant recurrence, DR），以及疾病特异性生存率（disease-specific survival, DSS）。
研究方法：本研究为一项回顾性多中心研究，纳入785例接受莫氏显微外科手术治疗的侵袭性头颈部黑色素瘤病例，术中采用冰冻切片联合MART-1免疫组化染色，以评估12年以上的长期预后。
研究结果：共785例厚度为0.3mm~8.5mm的黑色素瘤患者接受了莫氏显微外科手术治疗。整体局部复发率、区域淋巴结复发率及远处复发率分别为0.51%（4/785）、1.0%（8/785）及1.1%（9/785）。按T1、T2、T3、T4分期的肿瘤，其局部复发率分别为0.16%（1/636）、1.18%（1/85）、2.22%（1/45）及5.26%（1/19）。患者的5年及10年疾病特异性生存率分别为96.8%（95%置信区间95.0%~98.5%）与93.4%（95%置信区间88.5%~98.3%）。
研究局限性：本研究为非随机回顾性研究。
研究结论：相较于一项针对常规切除术治疗患者的历史队列荟萃分析结果，莫氏显微外科手术可显著降低局部复发风险。因此，莫氏显微外科手术应被视为侵袭性头颈部黑色素瘤的重要外科治疗选择。