Indian Journal of Dermatology
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Year : 2022  |  Volume : 67  |  Issue : 4  |  Page : 479

Mohs micrographic surgery for melanoma: A convincing treatment modality

1 From the Department of Dermatology, University of Maryland Medical Center, Baltimore, MD, USA
2 Department of Dermatology, Veterans Affairs Medical Center; Department of Dermatology, SUNY Downstate, Brooklyn, NY, USA

Correspondence Address:
Amor Khachemoune
Veterans Affairs Hospital and SUNY Downstate Dermatology Service, 800 Poly Place, Brooklyn, NY 11209
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijd.ijd_1074_20

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Mohs micrographic surgery (MMS) is the gold standard for treating keratinocyte carcinomas in specific locations or due to other tumor-specific factors, given its comprehensive margin assessment, tissue sparing, and high cure rate. The use of MMS for treating invasive melanoma with intraoperative immunostains is still a subject of debate. Herein, a literature review supports the following recommendations. In cosmetically or functionally demanding sites such as head, neck, hands, feet, and pretibial leg, we recommend MMS for MMIS and all thin melanomas measuring <0.8 mm Breslow depth. Additionally, on the head and neck, all superficial spreading and lentigo maligna melanoma (LMM) histologic subtypes <0.8 mm Breslow depth should be treated with MMS. We recommend using melanoma antigen recognized by T cells 1 (MART-1) immunostain intraoperatively given its high sensitivity. However, microphthalmia transcription factor (MITF) and Sry-related HMG-Box gene 10 (SOX10) are useful adjuncts for difficult cases.

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