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- Presentation
Mohs Surgery and Staged Excision for Melanoma
Description
The presentation focuses on Mohs surgery and staged excision for melanoma, discussing current guidelines from the American Academy of Dermatology (AAD) and the National Comprehensive Cancer Network (NCCN). Both guidelines recommend using Mohs surgery or staged excision for melanoma, particularly in high-risk areas, to ensure comprehensive margin assessment. However, there is an ongoing debate about the sufficiency of sub-1 cm surgical margins in achieving optimal outcomes, with current evidence being largely retrospective and lacking prospective trials comparing different surgical techniques. The speaker emphasizes the need for future research to establish clearer guidelines and the efficacy of Mohs versus staged excision. They introduce ongoing and proposed trials, such as the ICEMAN trial, aimed at providing more concrete data on surgical approaches for low-risk melanoma, especially in terms of local recurrence and patient outcomes. The current discussions highlight the gap between practice and evidence in the treatment of early-stage melanoma and the critical need for well-structured studies to support clinical decision-making.
View moreConclusions
- Both Mohs micrographic surgery and staged excision are acceptable techniques for treating melanoma, particularly in high-risk locations like the face, ears, and scalp.
- Current guidelines recommend that margin assessment be thorough, but suggest that surgical margins of less than 1 cm are not generally acceptable without further evidence.
- There is insufficient prospective data comparing the effectiveness of Mohs surgery versus staged excision for melanoma treatment, particularly for early-stage disease.
- Retrospective studies indicate that Mohs surgery may offer improved local recurrence rates and survival in specific melanoma cases, but results are inconclusive and varied.
- Ongoing research is required to address key questions regarding the adequacy of margins less than 1 cm for invasive melanomas and the best methods for margin assessment.
- Future trials, such as the ICEMAN study, aim to provide clearer insights into surgical approaches for melanoma and potentially validate the use of low-risk stratification methods to guide treatment choices.
- NCCN Melanoma Clinical Practice Guidelines, member
- AAD CPG 2019 recommendations
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