Gimme Mohs.

Because who wants a “wide” local excision (WLE) of their face, really? Mohs micrographic surgery comes to the cosmetic rescue of many a squam and basal cell cancer that puts down roots in high-stakes real estate. But it hasn’t yet taken off for melanoma given the notoriously difficult-to-interpret real-time H&E staining of the latter. What’s more, melanomas of the head and neck (H&N) have higher local recurrence rates than other areas of the body and are just plain scarier than other histologies. Mohs surgeons believe the 21st century solution to both poor cosmesis and higher recurrence rates is a Mohs micrographic surgery technique (obviously), this time incorporating immunohistochemistry (IHC). This large single institution review of outcomes of H&N melanomas after either WLE with 10-15 mm margins (n=97) or more finesse with Mohs stages of 2-3 mm margins using IHC (n=292). At a median follow-up of 20 months, Mohs significantly diminished rates of local recurrence, though the authors recognized larger lesions more commonly underwent WLE. More interesting was the persistent significant decrease among only those ≤0.8 mm thick: 2/292 (<1%) after Mohs versus 3/25 (12%) after WLE. TBL: When utilizing IHC, melanomas on the face should get at least as much TLC as squamous and basal cell carcinomas. | Demer, Dermatol Surg 2019