Upstaging of melanoma in situ and lentigo maligna treated with Mohs micrographic surgery rarely results in additional su
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Upstaging of melanoma in situ and lentigo maligna treated with Mohs micrographic surgery rarely results in additional surgical management Melissa A. Levoska1 · Chrysalyne D. Schmults2 · Abigail H. Waldman2 Received: 13 January 2020 / Revised: 15 January 2020 / Accepted: 18 January 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract As Mohs micrographic surgery (MMS) is more widely utilized for melanoma in situ (MIS) and lentigo maligna (LM), there is increasing concern over whether the procedure can negatively affect the treatment of upstaged tumors. Previous studies have shown that about 1–2% of MIS/LM treated with MMS require sentinel lymph node biopsy, but little is still known regarding surgical outcomes. We performed a retrospective chart review of 117 MIS/LM lesions treated with MMS at Brigham and Women’s Hospital. We found a low rate of tumor upstaging (8.5% or 10/117), and only 1.7% (2/117) required wide local excision and sentinel lymph node biopsy. In both patients, there was successful location of the sentinel nodes by surgical oncologists. This study highlights the low risk of MIS/LM upstaging, with the majority changing to T1a, and the low need for further surgical management after MMS. Collaboration with other surgical specialties ensures appropriate management of patients with upstaged tumors. Keywords Mohs micrographic surgery · Melanoma · Mohs for melanoma · Melanoma in situ · Lentigo maligna · Dermatologic surgery · Upstaged tumors · Upstaged melanomas · Wide local excision · Sentinel lymph node biopsy · Mohs surgery for upstaged melanomas Mohs micrographic surgery (MMS) is increasingly being used to treat melanoma in situ (MIS) and lentigo maligna (LM) [1, 2]. Previous studies have reported that 5.5–8.1% of MIS/LM are upstaged during MMS via evaluation of the debulking specimen [3, 4]. About 1–2% of MIS/LM treated with MMS may require sentinel lymph node biopsy (SLNB) [4]. The purpose of this retrospective chart review was to demonstrate that SLNB is rare after tumor upstaging and that collaboration with other surgical specialties allows for appropriate management. This study was approved by Partners Human Research Committee. Patients diagnosed with MIS/LM who were treated with MMS at Brigham and Women’s Hospital * Abigail H. Waldman [email protected] 1
Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
Department of Dermatology, Brigham and Women’s Hospital, Mohs and Dermatologic Surgery Center, Harvard Medical School, 1153 Centre Street, Suite 4J, Boston, MA 02130, USA
2
(BWH) were identified. Pathology reports from tumor debulking during MMS were read by the Mohs surgeon at the time of excision and then reviewed by a board-certified dermatopathologist. Tumors upstaged to invasive melanoma were included in the study. Tumors were staged according to the American Joint Committee on Cancer 8th edition staging (AJCC8) system. Electronic medical records and MM
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