Mohs vs. Wide Excision for Lentigo Maligna

Murad Alam, MD, MSCI reviewing Hou JL et al. Dermatol Surg 2015 Feb.

Mohs surgery more effectively cleared LM, despite the fact that higher-risk lesions were assigned to this technique.

When local excision is employed as a treatment modality for lentigo maligna, 0.5 to 1 cm margins are routinely used. To assess whether this approach is adequate to prevent high rates of recurrence, investigators compared wide local excision with Mohs surgery.

Hou et al performed a retrospective analysis of cases of lentigo maligna treated at the Mayo Clinic from 1995 to 2005. A total of 269 lesions were treated with wide local excision (5 mm margins) and 154 with Mohs surgery. Five-year recurrence rates were 1.9% in the Mohs group and 5.9% in the group that underwent wide local excision. This was not a randomized trial; the tumors treated with Mohs tended to be relatively higher risk, larger head and neck lesions with indistinct clinical margins. Approximately a third of the Mohs-treated lesions were assessed not only by hematoxylin and eosin staining but also with MART-1 immunostaining.

CITATION(S):

Hou JL et al. Five-year outcomes of wide excision and Mohs micrographic surgery for primary lentigo maligna in an academic practice cohort. Dermatol Surg 2015 Feb; 41:211.