Plastic Surgery Research Council

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Comparison of Invasive Melanoma Outcomes Treated with Mohs Micrographic Surgery Vs. Wide Local Excision in the United States
Daniel Boczar, MD, David J Restrepo, MD, Maria T. Huayllani, MD, Andrea Sisti, MD, Jeremie D. Oliver, BS, BA, Aaron C Spaulding, PhD, Jordan J Cochuyat, Sanjay Bagaria, MD, Emmanuel Gabriel, MD PhD, Brian D RInker, MD, Antonio Jorge Forte, MD. PhD.
Mayo Clinic Florida, Jacksonville, FL, USA.

PURPOSE
Current guidelines do not support the use of Mohs Micrographic Surgery (MMS) to treat invasive melanoma. We conducted this study to compare survival rates of invasive melanoma patients treated with MMS and Wide Local Excision (WLE) in the United States.
METHODS
National Cancer Database (NCDB) was used to select patients with invasive melanoma from 2004 to 2015 who underwent MMS or WLE. We assessed variables related to patient characteristics, hospital, tumor, treatment, and survival. Chi-Square and Mann-Whitney test were used to estimate statistical significance. Moreover, we calculated the five-year survival rate for WLE and MMS with stratification by tumor stage.
RESULTS
A total of 235148 patients met the criteria of the study. 9391 patients underwent MMS (4%), and 225757 underwent WLE (96%). The patients' mean age was 63.02 years (SD 16.08) for MMS and 60.11 years (SD16.44) for WLE. The mean time for patients who underwent MMS to start receiving treatment was 11.63 days, compared with 9.62 days of WLE (P = 0.001). Compared to WLE, after stratification by tumor stage, we noticed that 5 years survival rate was superior for MMS only for tumor Stage 4 (24% MMS vs. 17% WLE) and it was lower for stage 0 (64% MMS vs. 65% WLE), Stage I (72% MMS vs. 74% WLE), Stage II (41% MMS vs. 46% WLE), and Stage III (38% MMS vs. 43% WLE).
CONCLUSION
This study is the largest analysis of outcomes of invasive melanoma treated with MMS. When compared to WLE, MMS was associated with lower five-year survival rates for tumors Stage 0 to III.


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