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Soo Park, MD
Soo Park, MD
Posted: Monday, November 18, 2024
A study conducted by Wesley Y. Yu, MD, of Oregon Health & Science University, Portland, and colleagues established an expert consensus to standardize protocols and guidelines for Mohs micrographic surgery for future multicenter clinical trials in melanoma. Their report, which was published in JNCCN–Journal of the National Comprehensive Cancer Network, may facilitate comparisons of aggregate data.
“Although the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cutaneous Melanoma reference studies on the use of Mohs micrographic surgery in the surgical management of melanoma in situ, [the procedure] is not currently recommended in most cases,” the investigators commented. “This likely reflects the absence of consensus and high-quality prospective data on this topic.”
The investigators performed a literature review and interviewed experienced surgeons to identify dimensions of the Mohs micrographic surgery technique for melanoma in situ that both likely impacted costs or outcomes of the procedure and showed significant variability between surgeons. They ultimately selected eight dimensions of technical variation. A two-round modified Delphi survey was conducted, during which 44 expert Mohs surgeons from the United States rated their agreement with specific recommendations on a Likert scale.
Five of the eight recommendations achieved consensus in the first round of voting. They included the use of a starting peripheral margin of up to 5 mm, the application of immunohistochemistry, frozen tissue processing, and resection to the depth of subcutaneous fat. Consensus on the remaining three surgical dimensions, which addressed the use of Wood’s lamp, dermatoscopy, and negative tissue controls, was established in the second round.
“Although this study addressed eight important aspects of the Mohs micrographic surgery technique that lacked standardization, future studies are needed to explore others that were not evaluated,” the investigators concluded. “[They] may include laboratory practices, tissue section thickness, appropriate trimming of the tissue block, and approaches to atypical melanocytic hyperplasia.”
Disclosure: The study authors reported no conflicts of interest.
JNCCN–Journal of the National Comprehensive Cancer Network
JNCCN Spotlights
