Melanoma Upstaging During Mohs Micrographic Surgery: A Single-Center 12-Year Experience
Sujitha Yadlapati, Maria Melendez-Gonzalez, Olufolakemi Awe, Lindsay P. Osborn, Bradley G. MerrittBACKGROUND
Mohs micrographic surgery (MMS) with MART-1/Melan-A immunostaining is increasingly used for melanoma in situ and invasive melanoma. Permanent section analysis of the central debulking specimen can reveal previously unrecognized or deeper invasion, resulting in tumor upstaging, but the frequency and clinical yield of this practice remain unclear.
OBJECTIVE
To determine the frequency of melanoma upstaging on debulking specimens and compare routine versus selective, frozen section-guided submission.
MATERIALS AND METHODS
Single-center retrospective review of all cutaneous melanomas treated with MMS by one surgeon (2010–2022). Debulking specimens were submitted routinely (2010–2015) or selectively based on intraoperative frozen section features (2016–2022). The Fisher exact test was used to compare upstaging between eras.
RESULTS
Among 2,017 melanomas (75.8% in situ), 36 (1.8%; 95% CI: 1.3%–2.5%) were upstaged, all by increased Breslow depth. Overall upstaging was 2.5% (routine) versus 1.5% (selective) (
CONCLUSION
Melanoma upstaging during MMS is uncommon and usually low risk, supporting a selective, individualized approach to permanent section submission guided by intraoperative frozen section findings.