Survival Outcomes of Patients With Melanoma Treated With Mohs Micrographic Surgery: A Systematic Review and Meta-Analysis

BACKGROUND: Wide local excision (WLE) is the standard treatment for cutaneous melanoma. Mohs micrographic surgery (MMS), a tissue-sparing technique with comprehensive margin assessment, is an alternative in selected cases. With increased MMS use, its optimal scope for melanoma treatment remains under discussion due to the complexity of frozen-section interpretation and lack of randomized trials evaluating long-term outcomes. OBJECTIVE: To compare survival between MMS and WLE for melanoma. METHODS/MATERIALS: PubMed, Embase, and Cochrane databases were systematically searched for comparative studies reporting overall or disease-specific survival. Outcomes were compared using adjusted hazard ratios (95% confidence intervals). Heterogeneity was assessed with I2. RESULTS: Thirteen studies with more than 500,000 individuals were included in the statistical analysis. Long-term overall (HR = 0.93; 95% CI = 0.87-0.99; p-value = .03) and disease-specific survival (HR = 0.63; 95% CI = 0.56-0.72; p-value<.00001) were significantly higher with MMS versus WLE. Overall survival benefit was mainly driven by head/neck melanoma (HR = 0.92; 95% CI = 0.86-0.99; p-value = .03), particularly invasive disease (HR = 0.91; 95% CI = 0.84-0.99; p-value = .03). Lentigo maligna subtype also showed higher overall survival with MMS (HR = 0.89; 95% CI = 0.82-0.97; p-value = .006). No difference was observed in 5-year overall or disease-specific survival (HR = 0.92; 95% CI = 0.80-1.05; p-value = .12 and HR = 0.87; 95% CI = 0.56-1.34; p-value = .52; respectively). CONCLUSION: MMS was consistently associated with survival similar or superior to WLE, supporting its expanding role in melanoma management.