Mohs data.

Top Line: Mohs surgery is looking to expand its minuscule-margin curative techniques across wider horizons.

The Study: A recent single-institution review from the University of Minnesota suggested Mohs may be a, not only acceptable, but perhaps even preferable treatment modality for early-stage cutaneous melanomas. The next step in this possible paradigm shift is, of course, a larger NCDB analysis. This one included all patients receiving surgical excision alone for stage I (<2 mm thick) cutaneous melanoma in the decade between 2004-2014. All in all, there were 67K cases post-wide excision and 3200 post-Mohs micrographic surgery. The primary endpoint of overall survival was determined to be statistically superior with Mohs versus wide excision with hazard ratios for death of 0.86 on multivariate analysis and 0.82 on propensity score matching. The secondary endpoint of determinants of receiving Mohs surgery in the first place clearly pointed to receiving care at an academic facility, which doubled the odds. Perhaps because Mohs for melanoma traditionally calls for MART-1 immunostaining, which requires special training and expertise on top of being time-consuming and expensive, without a differentiated reimbursement from the quick and dirty H&E staining of standard Mohs for squams and basal cells.

TBL: Even more data demonstrates Mohs micrographic surgery is an effective, cosmesis-sparing treatment modality for early-stage cutaneous melanoma, which may deserve re-exploration for equitable reimbursement. | Cheraghlou, JAMA Dermatol 2019