Mohs micrographic surgery versus wide local excision for melanoma in situ : analysis of a nationwide database

Background With the rising incidence of melanoma in situ ( MIS ) or cutaneous melanoma, there is an increasing emphasis on the need to understand optimal treatment strategies. The current standard of surgical care is wide local excision ( WLE ). Alternative surgical techniques have been proposed including Mohs micrographic surgery ( MMS ). We aimed to compare survival rates following WLE versus MMS surgery for MIS . Methods We performed a retrospective analysis of the Surveillance, Epidemiology, and End Results ( SEER ) cancer registry. 24,515 cases of WLE were identified and compared with 4122 cases of MMS surgery for MIS . Results There was a significantly higher proportion of elderly patients aged ≥75 years in the MMS group compared to WLE (23.3% vs. 15.3%). The proportion of females was higher for WLE compared to MMS (48.8% vs. 40%). Facial MIS tumors were significantly higher for MMS , as were scalp/neck tumors. After adjustment for confounding factors, there was no significant difference in cancer‐specific survival ( HR 0.928, 95% CI 0.596–1.446, P  = 0.74) and overall survival ( HR 1.006, 95% CI 0.896–1.129, P  = 0.924). Conclusion Adjusted analyses demonstrated no differences in overall survival or cancer‐specific survival between MIS patients treated with MMS compared with WLE .