Improved overall survival of melanoma of the head and neck treated with Mohs micrographic surgery versus wide local excision

Abstract

Optimal surgical management for melanoma of the head and neck remains controversial. Assess outcomes for melanomas of the head and neck treated with Mohs micrographic surgery (MMS) versus wide local excision (WLE) from the National Cancer Database. Head and neck melanoma data from the National Cancer Database from years 2004-2015 were analyzed. In total, 50,397 cases of head and neck melanoma were reviewed; 3510 (7%) were treated with MMS and 46,887 (93%) with WLE. After controlling for potential confounding variables, patients treated with MMS were more likely than patients treated with WLE to survive after 5years (hazard ratio [HR] 1.181, 95% confidence interval [CI] 1.083-1.288; P<.001). Factors associated with a statistically significant survival disadvantage included male sex (HR 1.287, 95% CI 1.242-1.357; P=0), tumor ulceration (HR 1.687, 95% CI 1.616-1.760; P=0), and positive surgical margins (HR 1.395, 95% CI 1.306-1.490; P=0). Patient survival was inversely proportional to tumor Breslow depth. Database study, limited number of MMS treated melanomas. MMS is a valid treatment option for melanoma of the head and neck; National CancerDatabase data suggests that MMS might confer a survival benefit over WLE.