BACKGROUND: Published appropriate use criteria (AUC) for Mohs micrographic surgery (MMS) for melanoma are based on consensus opinion. OBJECTIVE: To evaluate whether published AUC identify melanomas for which MMS may benefit patients by detecting subclinical spread or confirming clear microscopic margins before flap or graft reconstruction. MATERIALS AND METHODS: Retrospective cohort study of 591 melanomas in 556 patients evaluating the correlation between current AUC (anatomic location, recurrent status, and tumor stage) and subclinical spread or reconstruction with a flap or graft. RESULTS: Anatomic location on the head, neck, genitalia, hands, feet, or pretibial leg was associated with a significantly higher frequency of subclinical spread (odds ratio (OR) 1.89, p = .0280) and flap or graft reconstruction (OR 10.3, p = .0001). Compared with primary lesions, recurrent melanomas had a higher frequency of subclinical spread (OR 1.78, p = .0104) and reconstruction with a flap or graft (OR 1.67, p = .0217). The frequencies of subclinical spread and flap or graft reconstruction did not differ between in situ and invasive melanomas. CONCLUSION: Anatomic location and recurrent status are useful criteria to identify melanomas that may benefit from MMS. Tumor stage is not a useful criterion, as MMS has similar benefits for subsets of both invasive and in situ melanomas.
BACKGROUND: Published appropriate use criteria (AUC) for Mohs micrographic surgery (MMS) for melanoma are based on consensus opinion. OBJECTIVE: To evaluate whether published AUC identify melanomas for which MMS may benefit patients by detecting subclinical spread or confirming clear microscopic margins before flap or graft reconstruction. MATERIALS AND METHODS: Retrospective cohort study of 591 melanomas in 556 patients evaluating the correlation between current AUC (anatomic location, recurrent status, and tumor stage) and subclinical spread or reconstruction with a flap or graft. RESULTS: Anatomic location on the head, neck, genitalia, hands, feet, or pretibial leg was associated with a significantly higher frequency of subclinical spread (odds ratio (OR) 1.89, p = .0280) and flap or graft reconstruction (OR 10.3, p = .0001). Compared with primary lesions, recurrent melanomas had a higher frequency of subclinical spread (OR 1.78, p = .0104) and reconstruction with a flap or graft (OR 1.67, p = .0217). The frequencies of subclinical spread and flap or graft reconstruction did not differ between in situ and invasive melanomas. CONCLUSION: Anatomic location and recurrent status are useful criteria to identify melanomas that may benefit from MMS. Tumor stage is not a useful criterion, as MMS has similar benefits for subsets of both invasive and in situ melanomas.
Authors: Suzanne M Connolly; Diane R Baker; Brett M Coldiron; Michael J Fazio; Paul A Storrs; Allison T Vidimos; Mark J Zalla; Jerry D Brewer; Wendy Smith Begolka; Timothy G Berger; Michael Bigby; Jean L Bolognia; David G Brodland; Scott Collins; Terrence A Cronin; Mark V Dahl; Jane M Grant-Kels; C William Hanke; George J Hruza; William D James; Clifford Warren Lober; Elizabeth I McBurney; Scott A Norton; Randall K Roenigk; Ronald G Wheeland; Oliver J Wisco Journal: J Am Acad Dermatol Date: 2012-09-05 Impact factor: 11.527
Authors: Shaloam Dasari; Clement G Yedjou; Robert T Brodell; Allison R Cruse; Paul B Tchounwou Journal: Nanotechnol Rev Date: 2020-12-31 Impact factor: 7.848