TY - JOUR
T1 - Improved overall survival of melanoma of the head and neck treated with Mohs micrographic surgery versus wide local excision
AU - Hanson, Jamie
AU - Demer, Addison
AU - Liszewski, Walter
AU - Foman, Neal
AU - Maher, Ian
N1 - Publisher Copyright:
© 2019 American Academy of Dermatology, Inc.
PY - 2020/1
Y1 - 2020/1
N2 - Background: Optimal surgical management for melanoma of the head and neck remains controversial. Objective: Assess outcomes for melanomas of the head and neck treated with Mohs micrographic surgery (MMS) versus wide local excision (WLE) from the National Cancer Database. Methods: Head and neck melanoma data from the National Cancer Database from years 2004-2015 were analyzed. Results: In total, 50,397 cases of head and neck melanoma were reviewed; 3510 (7%) were treated with MMS and 46,887 (93%) with WLE. After controlling for potential confounding variables, patients treated with MMS were more likely than patients treated with WLE to survive after 5 years (hazard ratio [HR] 1.181, 95% confidence interval [CI] 1.083-1.288; P <.001). Factors associated with a statistically significant survival disadvantage included male sex (HR 1.287, 95% CI 1.242-1.357; P = 0), tumor ulceration (HR 1.687, 95% CI 1.616-1.760; P = 0), and positive surgical margins (HR 1.395, 95% CI 1.306-1.490; P = 0). Patient survival was inversely proportional to tumor Breslow depth. Limitations: Database study, limited number of MMS treated melanomas. Conclusion: MMS is a valid treatment option for melanoma of the head and neck; National Cancer Database data suggests that MMS might confer a survival benefit over WLE.
AB - Background: Optimal surgical management for melanoma of the head and neck remains controversial. Objective: Assess outcomes for melanomas of the head and neck treated with Mohs micrographic surgery (MMS) versus wide local excision (WLE) from the National Cancer Database. Methods: Head and neck melanoma data from the National Cancer Database from years 2004-2015 were analyzed. Results: In total, 50,397 cases of head and neck melanoma were reviewed; 3510 (7%) were treated with MMS and 46,887 (93%) with WLE. After controlling for potential confounding variables, patients treated with MMS were more likely than patients treated with WLE to survive after 5 years (hazard ratio [HR] 1.181, 95% confidence interval [CI] 1.083-1.288; P <.001). Factors associated with a statistically significant survival disadvantage included male sex (HR 1.287, 95% CI 1.242-1.357; P = 0), tumor ulceration (HR 1.687, 95% CI 1.616-1.760; P = 0), and positive surgical margins (HR 1.395, 95% CI 1.306-1.490; P = 0). Patient survival was inversely proportional to tumor Breslow depth. Limitations: Database study, limited number of MMS treated melanomas. Conclusion: MMS is a valid treatment option for melanoma of the head and neck; National Cancer Database data suggests that MMS might confer a survival benefit over WLE.
KW - Mohs micrographic surgery
KW - NCDB
KW - melanoma
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U2 - 10.1016/j.jaad.2019.08.059
DO - 10.1016/j.jaad.2019.08.059
M3 - Article
C2 - 31473297
AN - SCOPUS:85075498363
SN - 0190-9622
VL - 82
SP - 149
EP - 155
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
IS - 1
ER -