Treatment of cutaneous melanoma of the face by Mohs micrographic surgery.

Background: The treatment of cutaneous malignant melanoma of the face presents a challenge to ensure eradication of disease with maximum preservation of tissue. Mohs micrographic surgery provides a means for histologically controlled removal of malignant melanoma.

Objective: This study evaluates the efficacy of Mohs micrographic surgery, at a single institution, for the treatment of facial melanoma and assesses the accuracy of margin control by frozen section techniques.

Methods: Ninety-seven patients with biopsy-confirmed melanoma in situ or invasive melanoma of the face were treated by Mohs micrographic surgery over a 6-year period. In 25 patients, tissue margins defined as negative for melanoma at the time of frozen section were re-evaluated on permanent section histology of formalin-fixed, paraffin-embedded tissue.

Results: Ninety-two of 97 patients had followup information available (8-72 months; mean 33 months). There were no cases of local recurrence. Eighty-nine of the 92 patients were alive and well with no evidence of disease. One patient died of metastatic melanoma. In situ or invasive melanoma was not identified on permanent sections of 117 tissue margins which had been interpreted as negative on frozen section.

Conclusion: Mohs micrographic surgery appears to be an effective treatment for facial melanomas. Our study showed complete correlation between frozen section tissue margins and permanent section controls.