Melanomas of the head and neck have high local recurrence risk features and require tissue rearranging reconstruction more commonly than BCC and SCC: A comparison of indications for microscopic margin control prior to reconstruction in 13,664 tumors

Publication date: Available online 17 November 2018

Source: Journal of the American Academy of Dermatology

Author(s): William Fix, Jeremy R. Etzkorn, Thuzar M. Shin, Nicole Howe, Mehul Bhatt, Joseph F. Sobanko, Christopher J. Miller

Abstract

Background

Consensus guidelines recommend microscopic margin control based on high local recurrence risk features and tissue-rearranging reconstruction for keratinocyte carcinomas (KC) but not for cutaneous melanoma.

Objective

To compare high local recurrence risk features and frequency of tissue-rearranging reconstruction for head and neck KC versus melanoma.

Methods

Retrospective cohort study of KC versus melanoma treated at the Hospital of the University of Pennsylvania with Mohs micrographic surgery (MMS).

Results

12,189 KCs (8,743 BCC, 3,343 SCC) and 1,475 melanomas (1065 melanomas in situ, 410 invasive melanomas) were identified from a prospectively updated MMS database. Compared to KCs, melanomas were significantly more likely to have high local recurrence risk features, including larger preoperative size [2.10 cm vs 1.30 cm, (p <0.0001)], recurrent status [5.08% vs 3.91%, (p = 0.031)], and subclinical spread [31.73% vs 26.52%, (p <0.0001)]. Tissue rearranging reconstruction was significantly more common for melanoma versus KCs [44.68% vs 33.02%, (p < 0.0001); OR 1.98 (p<0.0001)].

Limitations

This was a retrospective study and did not compare outcomes to other treatment methods, such as "slow-Mohs" or conventional excision.

Conclusion

Melanomas of the head and neck have high local recurrence risk features and require tissue rearranging reconstruction more frequently than KCs.

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