Abstract
Background: Surveys suggest wide-spread use of MART-1 in MMS for CM among Mohs surgeons, but no previous systematic review has investigated the efficacy of this specific procedure. Methods: A systematic search and meta-analysis of retrospective studies on MMS with MART-1 was performed from Pubmed, Medline, and Cochrane databases for articles published from their inception to October 30, 2020. We performed a chi-squared analysis of homogenized data to examine the relationship between recurrence location and rate of recurrence. A risk of bias was obtained with the ROBINS-I tool. [PROSPERO ID: CRD42020221826] Results: Among the included studies, there were a total of 15 (0.52%) local recurrences of melanoma in-situ and invasive melanoma after MMS with MART-1. Conclusions: This review has served to demonstrate that MMS with MART-1 immunostaining in frozen sections is a technique that produces satisfactory recurrence rates for melanoma in-situ and invasive melanoma.
Highlights
Cutaneous melanoma (CM) affects about 287,000 people each year, worldwide.[1]
Current surgical recommendations for primary CM include surgical excision with pre-determined surgical margins based on tumor characteristics and subsequent microscopic margin assessment - as needed
Wide local excision (WLE) continues to be the primary recommendation of the American Academy of Dermatology (AAD), with margins predicated by tumor depth.[3]
Summary
Cutaneous melanoma (CM) affects about 287,000 people each year, worldwide.[1]. Worse prognoses are associated with CM located on the head, neck, and trunk compared to extremities - with the exception of acral melanoma.[2]. Wide local excision (WLE) continues to be the primary recommendation of the American Academy of Dermatology (AAD), with margins predicated by tumor depth.[3] Extra consideration must be made for anatomically constrained sites and/or when subclinical spread is suspected. Mohs micrographic surgery (MMS) is recommended to treat primary melanoma in situ and lentigo maligna located on the head and neck, acral sites, genitalia, and pretibial leg, and for locally recurrent melanoma in situ lentigo maligna in any location.[4] The 2019 AAD workgroup has encouraged further study of MMS on these anatomically constrained areas. [PROSPERO ID: CRD42020221826] Results: Among the included studies, there were a total of 15 (0.52%) local recurrences of melanoma in-situ and invasive melanoma after MMS with MART-1. Conclusions: This review has served to demonstrate that MMS with MART-1 immunostaining in frozen sections is a technique that produces satisfactory recurrence rates for melanoma in-situ and invasive melanoma
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