Disease-specific survival of malignant melanoma after Mohs micrographic surgery is not impacted by initial margins: A systematic review and meta-analysis

Background: During Mohs surgery for melanoma, evidence has demonstrated that many surgeons opt for smaller initial margins than traditionally recommended (0.5 cm for in situ and 1 cm for invasive). Literature regarding surgical outcomes based on initial margin is sparse. Objective: To determine differences in disease -specific survival of melanoma after Mohs micrographic surgery for varied initial surgical margins. Methods: A literature search was conducted on February 14, 2022, from MEDLINE via PubMed (1946present), Embase (1974 -present), Central (1991 -present), and Scopus (1960 -present). The primary outcome was disease -specific mortality. Results: Nineteen studies were included for final analysis. The overall disease -specific mortality rate of melanoma in all included studies was 0.5% (CI, 0.1-0.8; P , .010). Disease -specific mortality for 1 to 5, 5, and 6 to 10 mm categories were 0.4% (CI, 0.0-0.9; P , .074), 0.7% (CI, 0.2-1.3; P , .2-1.3), and 0.4% (CI, e 0.9 to 1.8; P , .524), respectively. None of the variances across initial margin categories were statistically significant. Limitations: Early -stage melanomas have low overall mortality rates. In our associated article, initial margins of 5 to 10 mm were shown to have the lowest rates of local recurrence. Conclusions: In this systematic review and meta -analysis, melanoma -specific mortality was not significantly impacted by the initial surgical margin taken during Mohs micrographic surgery.