Is Mohs surgery appropriate therapy for malignant melanoma?

The use of Mohs surgery for melanoma varies between practitioners. Many dermatologic surgeons perform Mohs surgery on lentigo maligna, as the poorly defined margins of the tumor make it a good candidate for the technique. Some surgeons perform Mohs surgery on melanocytic tumors with fresh frozen sections alone, while others perform special stains such as Melan-A (MART-1) to better highlight the atypical melanocytes. The use of Mohs for invasive melanoma remains more controversial. Multiple studies have reported 5-year cure rates with Mohs surgery for invasive melanoma as being equivalent or better than those seen with standard wide local excision. However, some practitioners feel that fresh frozen tissue does not allow adequate assessment of melanocytic tumors. Modifications of the Mohs technique, such as “slow Mohs” with rush permanent paraffin sections, has been advocated as a way to perform tissue sparing surgery without fresh frozen sections.

Whalen J, Leone D: Mohs micrographic surgery for the treatment of malignant melanoma, Clin Dermatol 27:597–602, 2009.