Establishing Consensus for Mohs Micrographic Surgical Techniques in the Treatment of Melanoma in Situ for Future Clinical Trials: A Modified Delphi Study

Authors

Kristen K. Curtis, Case Western Reserve University School of Medicine, Cleveland, OH.
Nathan J. Fakult, Case Western Reserve University School of Medicine, Cleveland, OH.
Jennifer L. Strunck, Department of Dermatology, Oregon Health & Science University, Portland, OR.
Sumaira Z. Aasi, Department of Dermatology, Stanford University School of Medicine, Palo Alto, CA.
Christine S. Ahn, Department of Dermatology and Pathology, Wake Forest School of Medicine, Winston-Salem, NC.
Murad Alam, Departments of Dermatology and Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Anna A. Bar, Department of Dermatology, Oregon Health & Science University, Portland, OR.
Ramona Behshad, Department of Dermatology, SLUCare, SSM Health, St. Louis, MS.
Christopher K. Bichakjian, Department of Dermatology, University of Michigan, Ann Arbor, MI.
Diana Bolotin, Section of Dermatology, Department of Medicine, University of Chicago, Chicago, IL.
Susan L. Boone, Department of Dermatology, University of California, Davis School of Medicine, Sacramento, CA.
Jeremy S. Bordeaux, Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH.
Jerry D. Brewer, Division of Dermatologic Surgery, Department of Dermatology, Mayo Clinic, Rochester, MN.
David R. Carr, Department of Dermatology, The Ohio State University Medical Center, Columbus, OH.
John A. Carucci, The Ronald O. Perelman Department of Dermatology, NYU Langone, New York, NY.
Jason R. Castillo, Division of Dermatology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA.
Sean R. Christensen, Department of Dermatology, Yale School of Medicine, New Haven, CT.
Melanie A. Clark, Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI.
Lindsey K. Collins, Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
Addison M. Demer, Division of Dermatologic Surgery, Department of Dermatology, Mayo Clinic, Rochester, MN.
Daniel B. Eisen, Department of Dermatology, University of California, Davis School of Medicine, Sacramento, CA.
Hao Feng, Department of Dermatology, University of Connecticut, Farmington, CT.
Bahar F. Firoz, Department of Dermatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
Roy C. Grekin, Department of Dermatology, University of California, San Francisco, San Francisco, CA.
Jason M. Hirshburg, Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
Todd E. Holmes, Division of Dermatology, University of Vermont Medical Center, Burlington, VT.
Conway C. Huang, Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL.
Thomas A. Jennings, Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AK.
Shang I. Jiang, Department of Dermatology, University of California, San Diego, CA.
Sailesh Konda, Department of Dermatology, University of Florida College of Medicine, Gainesville, FL.
Justin J. Leitenberger, Department of Dermatology, Oregon Health & Science University, Portland, OR.
Jesse M. Lewin, The Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, NY.

Document Type

Article

Publication Title

Journal of the National Comprehensive Cancer Network : JNCCN

Abstract

BACKGROUND: Mohs micrographic surgery (MMS) is a promising treatment modality for melanoma in situ (MIS). However, variations in surgical technique limit the generalizability of existing data and may impede future study of MMS in clinical trials. METHODS: A modified Delphi method was selected to establish consensus on optimal MMS techniques for treating MIS in future clinical trials. The Delphi method was selected due to the limited current data, the wide range of techniques used in the field, and the intention to establish a standardized technique for future clinical trials. A literature review and interviews with experienced MMS surgeons were performed to identify dimensions of the MMS technique for MIS that (1) likely impacted costs or outcomes of the procedure, and (2) showed significant variability between surgeons. A total of 8 dimensions of technical variation were selected. The Delphi process consisted of 2 rounds of voting and commentary, during which 44 expert Mohs surgeons across the United States rated their agreement with specific recommendations using a Likert scale. RESULTS: Five of eight recommendations achieved consensus in Round 1. All 3 of the remaining recommendations achieved consensus in Round 2. Techniques achieving consensus in Round 1 included the use of a starting peripheral margin of ≤5 mm, application of immunohistochemistry, frozen tissue processing, and resecting to the depth of subcutaneous fat. Consensus on the use of Wood's lamp, dermatoscope, and negative tissue controls was established in Round 2. CONCLUSIONS: This study generated 8 consensus recommendations intended to offer guidance for Mohs surgeons treating MIS. The adoption of these recommendations will promote standardization to facilitate comparisons of aggregate data in multicenter clinical trials.

DOI

10.6004/jnccn.2024.7036

Publication Date

7-30-2024

Identifier

39079545 (pubmed); 10.6004/jnccn.2024.7036 (doi); e247036 (pii)

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