Daniela Frankel BS , Karla Valdes-Morales MD , Mara D. Trifoi MD , Stephanie K. Lin MD , Annika M. Deitermann MD , Manisha Banala BBA , Esther Zhang BS , Nicole Easo BA , Marissa Lubeck BS , Dylan Haynes MD , Daniel Lewis MD , Shannon T. Nugent MD , Jeremy R. Etzkorn MD , Neha N. Jariwala MD , Junqian Zhang MD , Joanna L. Walker MD , H. William Higgins II MD, MBE , Joseph F. Sobanko MD, MBA , Cerrene N. Giordano MD , Parnaz Daneshpajouhnejad MD , Christopher J. Miller MD
{"title":"一项回顾性队列研究：与传统的手足黑色素瘤切除术相比，Mohs显微摄影手术降低了阳性边缘重建的风险、重复手术和最终重建的时间。","authors":"Daniela Frankel BS , Karla Valdes-Morales MD , Mara D. Trifoi MD , Stephanie K. Lin MD , Annika M. Deitermann MD , Manisha Banala BBA , Esther Zhang BS , Nicole Easo BA , Marissa Lubeck BS , Dylan Haynes MD , Daniel Lewis MD , Shannon T. Nugent MD , Jeremy R. Etzkorn MD , Neha N. Jariwala MD , Junqian Zhang MD , Joanna L. Walker MD , H. William Higgins II MD, MBE , Joseph F. Sobanko MD, MBA , Cerrene N. Giordano MD , Parnaz Daneshpajouhnejad MD , Christopher J. Miller MD","doi":"10.1016/j.jaad.2025.03.012","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Hand and foot melanomas (HFMs) have increased risk for positive margins after conventional excision (CE). Mohs micrographic surgery (MMS) may improve margin clearance prior to reconstruction. Rates of reconstruction with positive margins have not been compared after CE versus MMS for HFMs.</div></div><div><h3>Objective</h3><div>To compare rates of reconstruction with positive margins after CE or MMS of HFMs.</div></div><div><h3>Methods</h3><div>In situ and invasive melanomas of hands and feet treated with CE or MMS with melanoma antigen recognized by T cells-1 immunostaining between 1994 and 2023 were identified from an academic center. The primary outcome was rate of reconstruction with positive margins after CE versus MMS. Secondary outcomes were repeat excision and time to definitive reconstruction after CE versus MMS.</div></div><div><h3>Results</h3><div>Of 269 HFMs, 180 (66.91%) were treated with MMS versus 89 (33.09%) with CE. Reconstruction with positive margins after initial excision was significantly more likely after CE (20.22%) versus MMS (0%) (<em>P</em> < .001). Compared to MMS, CE had higher rates of repeat excisions (20.22% vs 1.67%) (<em>P</em> < .001) and longer mean time to definitive reconstruction (11.35 vs 1.44 days) (<em>P</em> < .001).</div></div><div><h3>Limitations</h3><div>Single-site, retrospective design.</div></div><div><h3>Conclusion</h3><div>Compared to MMS, CE of HFMs has higher rates of reconstruction with positive margins, repeat surgeries, and a longer time to definitive reconstruction.</div></div>","PeriodicalId":17198,"journal":{"name":"Journal of the American Academy of Dermatology","volume":"93 1","pages":"Pages 157-164"},"PeriodicalIF":12.3000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Mohs micrographic surgery reduces the risk of reconstruction with positive margins, repeat surgeries, and time to definitive reconstruction compared to conventional excision of hand and foot melanomas: A retrospective cohort study\",\"authors\":\"Daniela Frankel BS , Karla Valdes-Morales MD , Mara D. Trifoi MD , Stephanie K. Lin MD , Annika M. Deitermann MD , Manisha Banala BBA , Esther Zhang BS , Nicole Easo BA , Marissa Lubeck BS , Dylan Haynes MD , Daniel Lewis MD , Shannon T. Nugent MD , Jeremy R. Etzkorn MD , Neha N. Jariwala MD , Junqian Zhang MD , Joanna L. Walker MD , H. William Higgins II MD, MBE , Joseph F. Sobanko MD, MBA , Cerrene N. Giordano MD , Parnaz Daneshpajouhnejad MD , Christopher J. Miller MD\",\"doi\":\"10.1016/j.jaad.2025.03.012\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Hand and foot melanomas (HFMs) have increased risk for positive margins after conventional excision (CE). Mohs micrographic surgery (MMS) may improve margin clearance prior to reconstruction. Rates of reconstruction with positive margins have not been compared after CE versus MMS for HFMs.</div></div><div><h3>Objective</h3><div>To compare rates of reconstruction with positive margins after CE or MMS of HFMs.</div></div><div><h3>Methods</h3><div>In situ and invasive melanomas of hands and feet treated with CE or MMS with melanoma antigen recognized by T cells-1 immunostaining between 1994 and 2023 were identified from an academic center. The primary outcome was rate of reconstruction with positive margins after CE versus MMS. Secondary outcomes were repeat excision and time to definitive reconstruction after CE versus MMS.</div></div><div><h3>Results</h3><div>Of 269 HFMs, 180 (66.91%) were treated with MMS versus 89 (33.09%) with CE. Reconstruction with positive margins after initial excision was significantly more likely after CE (20.22%) versus MMS (0%) (<em>P</em> < .001). Compared to MMS, CE had higher rates of repeat excisions (20.22% vs 1.67%) (<em>P</em> < .001) and longer mean time to definitive reconstruction (11.35 vs 1.44 days) (<em>P</em> < .001).</div></div><div><h3>Limitations</h3><div>Single-site, retrospective design.</div></div><div><h3>Conclusion</h3><div>Compared to MMS, CE of HFMs has higher rates of reconstruction with positive margins, repeat surgeries, and a longer time to definitive reconstruction.</div></div>\",\"PeriodicalId\":17198,\"journal\":{\"name\":\"Journal of the American Academy of Dermatology\",\"volume\":\"93 1\",\"pages\":\"Pages 157-164\"},\"PeriodicalIF\":12.3000,\"publicationDate\":\"2025-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Academy of Dermatology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S019096222500430X\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/11 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"DERMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Academy of Dermatology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S019096222500430X","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/11 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"DERMATOLOGY","Score":null,"Total":0}
Mohs micrographic surgery reduces the risk of reconstruction with positive margins, repeat surgeries, and time to definitive reconstruction compared to conventional excision of hand and foot melanomas: A retrospective cohort study
Background
Hand and foot melanomas (HFMs) have increased risk for positive margins after conventional excision (CE). Mohs micrographic surgery (MMS) may improve margin clearance prior to reconstruction. Rates of reconstruction with positive margins have not been compared after CE versus MMS for HFMs.
Objective
To compare rates of reconstruction with positive margins after CE or MMS of HFMs.
Methods
In situ and invasive melanomas of hands and feet treated with CE or MMS with melanoma antigen recognized by T cells-1 immunostaining between 1994 and 2023 were identified from an academic center. The primary outcome was rate of reconstruction with positive margins after CE versus MMS. Secondary outcomes were repeat excision and time to definitive reconstruction after CE versus MMS.
Results
Of 269 HFMs, 180 (66.91%) were treated with MMS versus 89 (33.09%) with CE. Reconstruction with positive margins after initial excision was significantly more likely after CE (20.22%) versus MMS (0%) (P < .001). Compared to MMS, CE had higher rates of repeat excisions (20.22% vs 1.67%) (P < .001) and longer mean time to definitive reconstruction (11.35 vs 1.44 days) (P < .001).
Limitations
Single-site, retrospective design.
Conclusion
Compared to MMS, CE of HFMs has higher rates of reconstruction with positive margins, repeat surgeries, and a longer time to definitive reconstruction.
期刊介绍：
The Journal of the American Academy of Dermatology (JAAD) is the official scientific publication of the American Academy of Dermatology (AAD). Its primary goal is to cater to the educational requirements of the dermatology community. Being the top journal in the field, JAAD publishes original articles that have undergone peer review. These articles primarily focus on clinical, investigative, and population-based studies related to dermatology. Another key area of emphasis is research on healthcare delivery and quality of care. JAAD also highlights high-quality, cost-effective, and innovative treatments within the field. In addition to this, the journal covers new diagnostic techniques and various other topics relevant to the prevention, diagnosis, and treatment of skin, hair, and nail disorders.
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