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.