Mohs vs. Wide Local Excision for Early-Stage (AJCC 0-II) Cutaneous Head and Neck Melanoma: A Meta-Analysis
In brief
For melanoma in situ, Mohs showed 1.7% recurrence versus 6.3% after excision
Across 23 studies of early-stage head and neck melanoma, pooled local recurrence for melanoma in situ was 1.7% after Mohs surgery and 6.3% after wide excision. Mohs also had lower pooled rates of upstaging and repeat surgery, but none of the between-group differences was statistically significant, so the apparent advantage needs stronger comparative evidence.
- Journal
- Head & neck (Q1)
- Published
- 9 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Anna Ardoin, Srivatsa Surya Vasudevan, Kashmira C Rodrigues, Christopher J Vance, Jason D Pou, Cherie-Ann O Nathan
- PMID
- 42855971
- DOI
- 10.1002/hed.70511
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 13 October 2026): Meta-analysis, margins, de‑escalation in head‑neck melanoma
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.