Abstract
ABSTRACT
Objective
To compare oncologic outcomes of Mohs micrographic surgery (MMS) versus wide local excision (WLE) in the management of cutaneous head and neck melanoma (CHNM), including melanoma in situ (MIS) and Stage I–II invasive disease.
Study Design
Systematic review and meta‐analysis.
Methods
PubMed, Embase, ScienceDirect, and Web of Science were systematically searched for studies published between January 2000 and March 2026 that reported outcomes of MMS versus WLE for CHNM, including MIS and AJCC Stage I–II invasive disease. Outcomes of interest were recurrence, tumor upstaging, and secondary excision rates, which were pooled using a random‐effects meta‐analysis model. Sensitivity analyses were performed to assess robustness, and meta‐regression was used to explore sources of heterogeneity.
Results
Of 691 records screened, 23 studies comprising 7090 cases of early‐stage (AJCC Stage 0–II) CHNM were included. The median age was 68.8 years, and 68.4% of patients were male. For MIS, the pooled local recurrence rate was lower after MMS (1.7%; 95% CI: 0.7–4.4) than after WLE (6.3%; 95% CI: 3.4–11.4). Upstaging to invasive melanoma was likewise less frequent with MMS (3.3%; 95% CI: 2.1–4.9) than with WLE (8.1%; 95% CI: 4.3–14.8), as was secondary surgical excision (1.2%; 95% CI: 0.1–10.3 vs. 9.7%; 95% CI: 3.0–27.0). Among Stage I–II cases, the pooled recurrence rate was 1.3% (95% CI: 0.3–4.6) after MMS and 8.8% (95% CI: 1.3–41.0) after WLE.
Conclusion
Although none of the between‐group differences reached statistical significance, MMS showed consistently favorable trends in local control and in reducing upstaging and secondary procedures for early‐stage CHNM. These findings support consideration of MMS in appropriately selected patients.