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Trunk and Extremity Melanoma Debate: Similar Outcomes for Mohs Micrographic Surgery Versus Wide Local Excision

Melanoma cells.

Survival outcomes did not change significantly for patients with melanoma of the trunk or extremity when treated with Mohs micrographic surgery (MMS) compared with wide local excision, according to the results of a retrospective cohort study published recently in JAMA Dermatology. The retrospective cohort study was designed because previous studies indicated differences in overall survival outcomes for patients with head and neck cancers. However, this study indicates that those results do not apply to trunk and extremity tumors.

The investigators, led by first author Addison Demer, MD, Mohs micrographic surgeon and dermatologic oncologist at Mayo Clinic in Rochester, Minnesota, conducted a retrospective cohort study of 188,862 patients with in situ or invasive trunk and/or extremity melanomas included in the National Cancer Database from 2004 to 2015. For patients to be included in the study, data was needed for Breslow depth, removal by MMS or wide local excision, and survival status. Patients had a mean age 58.8 years, and 52.7% were male. Most patients (97.7%) were treated with wide local excision, and the remaining 2.3% underwent MMS.

The Kaplan-Meier estimator found that patients who underwent MMS had a higher five-year median overall survival compared with those who underwent wide local incision for all trunk and extremity tumors (86.1% vs 82.9%). However, when the multivariate Cox model was used, there was no difference in all-cause mortality, either for any subgroup (tumors of the trunk, upper extremity, or lower extremity) or for all patients with trunk and extremity tumors combined. In addition, no statistically difference in overall survival was observed at any site when only invasive tumors were included in the analysis.

The finding does not support the use of one treatment over the other because five year overall survival rates remained close.

"In contrast with previous database studies of head and neck melanoma, this analysis of 188,862 cases of trunk and extremity melanoma from the National Cancer Database did not demonstrate a difference in overall survival between MMS or wide local excision treatments," conclude Dr. Demer and colleagues. "These findings add to the existing body of evidence demonstrating that wide local excision is not associated with a greater survival benefit than MMS for treatment of cutaneous melanoma."

For More Information

Demer AM, Hanson JL, Maher IA & Lisewski W (2020). Association of Mohs micrographic surgery vs wide local excision with overall survival outcomes for patients with melanoma of the trunk and extremities. JAMA Dermatol. [Epub ahead of print] DOI:10.1001/jamadermatol.2020.3950 

Image credit: Dr. Lance Liotta Laboratory. Courtesy of the National Cancer Institute.

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