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| |  Mohs Micrographic Surgery Provides Highest Cure Rate For Cutaneous Melanoma SCHAUMBURG, IL -- February 27, 1998 -- Mohs micrographic surgery provides the highest cure rate for the treatment of primary cutaneous melanoma, according to a study recently published in the Journal of the American Academy of Dermatology. The Mohs procedure is a specialised, precise method of skin cancer removal in which the tumour is completely excised without the loss of wide margins of normal skin and without the risk of inadequate margins that may leave tumour behind. The study shows that Mohs surgery offers survival and metastatic (spread of cancer) rates equal to wide surgical excision, yet with significantly narrower margins and without the risk of local recurrence due to incomplete excision. "Our purpose was to determine the safety and efficacy of Mohs micrographic surgery for the treatment of cutaneous melanoma," said John Zitelli, M.D., first author of the study and president of the American College of Mohs Micrographic Surgery and Cutaneous Oncology. "These results demonstrate that the advantages of the Mohs procedure seen with basal and squamous cell carcinomas also apply to the treatment of melanoma," Zitelli said. "Overall, patients treated with Mohs surgery experience less recurrence of cancer at five years after surgery and they are also less likely to have recurring cancer than patients who have the traditional wide excision." Mohs micrographic surgery is a procedure involving the removal of diseased skin tissue and the immediate microscopic examination of underlying tissue. A precise mapping technique allows the surgeon to identify the exact location of remaining cancer tissue. Only the diseased tissue is removed, preserving as much of the surrounding normal tissue as possible, resulting in minimal cosmetic impact. Malignant melanoma, the most dangerous form of skin cancer, is quickly increasing in incidence. According to The American Academy of Dermatology, Americans have a one in 87 chance of developing melanoma during their lifetimes, which is a 1,800 percent increase since 1930. Its danger lies in its ability to rapidly spread to other organs, most commonly the lungs or the liver. Malignant melanoma is the cause of more than 75 percent of all deaths from skin cancer. This prospective study, which covered a period of 15 years (1980-1995), examines the results of 535 patients with 553 primary cutaneous melanomas that were treated with Mohs micrographic surgery. The survival rates of patients in the study group were compared with 15,798 historical control patients treated by standard wide margin surgical techniques. The metastases rate for various thicknesses of margin were compared with two separate historical control studies, totalling 1,842 patients. After five years, 99.5 percent of patients had no local recurrence of the cancer (the reappearance of tumour in or adjacent to the scar). For standard surgery, local recurrence rates are quoted at three percent to 15 percent. According to a separate study also published recently in the Journal of the American Academy of Dermatology, Mohs micrographic surgery is a useful alternative to standard surgery for removal of melanoma when preservation of healthy tissue is important, especially on the head, neck, hands and feet. "One of the major controversies in the treatment of melanoma is the amount of healthy tissue that must be removed along with the cancer to prevent recurrence," Dr. Zitelli said. "Until recently, it was believed that margins of five centimetres or more were necessary. “These new study results demonstrate that smaller margins are safe and effective, and they allow us to develop guidelines for predetermined surgical margins for the excision of melanoma." This study was conducted during the same 15 years as the first study and included the same population of 535 consecutive patients treated with Mohs surgery for 553 primary cutaneous melanomas. In 83 percent of the melanomas, complete removal was obtained with the first six millimetre margin of healthy tissue; in 12 percent, margins of nine millimetres were required; and in two percent, 1.2 centimetre margins were required for complete removal of the melanoma. In standard surgery, wide margins of two to three centimetres are often used for thick melanomas. Extensions of the melanomas, invisible to the naked eye, may grow beyond the boundaries of the visible cancer. The study showed that on the trunk and extremities of the body, these extensions of melanoma rarely extend more than nine millimetres from the clinical margins of the cancer. The surgical margin needed for excision of melanoma was determined by measuring the invisible extensions of tumour around the melanoma. The minimal surgical margin was six millimetres and the total margin was calculated by adding an additional three millimetres for any melanoma requiring a subsequent stage to remove the tumour completely. Removal of skin cancer is often complex because a tumour visible to the naked eye is usually the tip of the iceberg -- it may have roots that are invisible, extending beyond the boundaries of the visible cancer. If these cancer cells are not completely removed, they can lead to recurrence of the tumour. Common treatment methods are often unsuccessful because they rely on the human eye to determine the extent of the cancer. When too little tissue is removed, the cancer is not fully excised; when too much tissue is removed, healthy tissue is lost. Because the Mohs procedure is microscopically controlled, it removes all the cancer and preserves as much healthy tissue as possible.
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