Mohs micrographic surgery reduces the risk of reconstruction with positive margins, repeat surgeries, and time to definitive reconstruction compared to conventional excision of hand and foot melanomas: a retrospective cohort study.
Daniela Frankel, Karla Valdes-Morales, Mara D Trifoi, Stephanie K Lin, Annika M Deitermann, Manisha Banala, Esther Zhang, Nicole Easo, Marissa Lubeck, Dylan Haynes, Daniel Lewis, Shannon T Nugent, Jeremy R Etzkorn, Neha N Jariwala, Junqian Zhang, Joanna L Walker, H William Higgins, Joseph F Sobanko, Cerrene N Giordano, Parnaz Daneshpajouhnejad, Mitul Modi, Ines C Lin, Benjamin Chang, Jason Wink, Giorgos Karakousis, John Miura, Christopher J Miller
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引用次数: 0
Abstract
Background: Hand and foot melanomas (HFM) have increased risk for positive margins after conventional excision (CE). Mohs micrographic surgery (MMS) may improve margin clearance prior to reconstruction. Rates of reconstruction with positive margins have not been compared after CE versus MMS for HFM.
Objective: To compare rates of reconstruction with positive margins after CE or MMS of HFM.
Methods: In situ and invasive melanomas of hands and feet treated with CE or MMS with MART-1 immunostaining between 1994-2023 were identified from an academic center. The primary outcome was rate of reconstruction with positive margins after CE vs MMS. Secondary outcomes were repeat excision and time to definitive reconstruction after CE vs MMS.
Results: Of 269 HFM, 180 (66.91%) were treated with MMS versus 89 (33.09%) with CE. Reconstruction with positive margins after initial excision was significantly more likely after CE (20.22%) versus MMS (0%) [p<0.001]. Compared to MMS, CE had higher rates of repeat excisions (20.22% vs. 1.67%) [p<0.001] and longer mean time to definitive reconstruction (11.35 vs. 1.44 days) [p<0.001].
Limitations: Single site, retrospective design.
Conclusion: Compared to MMS, CE of HFMs has higher rates of reconstruction with positive margins, repeat surgeries, and a longer time to definitive reconstruction.
期刊介绍：
The Journal of the American Academy of Dermatology (JAAD) is the official scientific publication of the American Academy of Dermatology (AAD). Its primary goal is to cater to the educational requirements of the dermatology community. Being the top journal in the field, JAAD publishes original articles that have undergone peer review. These articles primarily focus on clinical, investigative, and population-based studies related to dermatology. Another key area of emphasis is research on healthcare delivery and quality of care. JAAD also highlights high-quality, cost-effective, and innovative treatments within the field. In addition to this, the journal covers new diagnostic techniques and various other topics relevant to the prevention, diagnosis, and treatment of skin, hair, and nail disorders.
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