J Am Acad Dermatol. 2025 Mar 11:S0190-9622(25)00430-X. doi: 10.1016/j.jaad.2025.03.012. Online ahead of print.
ABSTRACT
BACKGROUND: Hand and foot melanomas (HFM) 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 HFM.
OBJECTIVE: To compare rates of reconstruction with positive margins after CE or MMS of HFM.
METHODS: In situ and invasive melanomas of hands and feet treated with CE or MMS with MART-1 immunostaining between 1994-2023 were identified from an academic center. The primary outcome was rate of reconstruction with positive margins after CE vs MMS. Secondary outcomes were repeat excision and time to definitive reconstruction after CE vs MMS.
RESULTS: Of 269 HFM, 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<0.001]. Compared to MMS, CE had higher rates of repeat excisions (20.22% vs. 1.67%) [p<0.001] and longer mean time to definitive reconstruction (11.35 vs. 1.44 days) [p<0.001].
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.
PMID:40081664 | DOI:10.1016/j.jaad.2025.03.012