Excision Margins for Melanoma in Situ on the Head and Neck

In a presentation on excision margins for melanoma in situ (MIS) on the head and neck, a surgeon from UT Southwestern discusses findings from a ten-year retrospective review of patients treated with Mohs micrographic surgery. The study involves 846 patients and addresses the inadequacy of the current guidelines recommending a 5 to 10 mm margin, highlighting significant subclinical spread in head and neck cases. The research aimed to determine optimal excision margins and the factors influencing the required margin size. Results indicate that a 5 mm margin only clears 62% of tumors, while an 8 mm margin clears 73%, a 10 mm margin clears 90%, and a 15 mm margin clears 97%. The study noted that tumor location is significant, with cheek tumors often requiring larger margins compared to those on the ear. Additionally, larger preoperative tumor sizes correlated with the need for larger margins. The conclusion encourages considering Mohs surgery for head and neck melanoma and suggests using greater than 10 mm margins for wide local excisions, especially for larger tumors or those located on the cheek.