Mohs and melanoma: an evolving role

Mohs surgery built its reputation on basal and squamous cell carcinomas, but its role in melanoma, the most serious skin cancer, has been evolving, an area worth understanding for patients and a good example of how the technique is advancing.

Melanoma was historically treated with wide local excision because of concerns about reliably identifying melanoma cells on the frozen sections Mohs uses. Advances in staining techniques, particularly immunostains that highlight melanoma cells, have improved the ability to read melanoma margins during Mohs or closely related staged-excision approaches. As a result, Mohs and these techniques are increasingly used for certain melanomas, especially the in-situ (earliest, surface-confined) type and melanomas on the face and other cosmetically sensitive areas, where the tissue conservation and thorough margin control are valuable.

This remains an area where appropriate use is guided by the type and stage of melanoma and by the surgeon's expertise, and wide excision is still standard for many melanomas. But the expanding application of Mohs-based techniques to select melanomas reflects genuine progress. Clinics that stay current with these methods tend to coordinate melanoma care carefully, an approach reflected in the coverage leading dermatology practices publish. For patients with an appropriate melanoma, discussing whether a Mohs-based approach fits is increasingly worthwhile.

Related reading: Mohs for skin cancers that came back and The microscopic mapping that makes Mohs precise.