Dawn Marianne Edwards, Dawn Aerlyn G, Miller Stanley J
Department of Dermatology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Dermatol Surg. 2007 Apr;33(4):395-402. doi: 10.1111/j.1524-4725.2007.33085.x.
Controversy exists in the literature regarding the use of Mohs surgery for the treatment of melanoma in situ (MIS). Mohs surgery provides the advantage of complete margin assessment; however, variations in surgical and laboratory techniques employed, make comparison of outcomes difficult.
To review the current literature regarding Mohs surgery for treatment of MIS and to evaluate treatment options.
We review the literature regarding traditional excision margins for MIS, the proportion of biopsy-proven MIS lesions that prove to have an invasive component, and the efficacy of Mohs surgery for MIS.
Many authors report a need for surgical margins larger than the recommended 5 mm, particularly with MIS arising in sun-exposed areas. Further, a review of the literature reveals that nearly one-quarter of biopsy-proven MIS lesions are found to contain invasive melanoma after complete surgical removal and pathologic examination. Substantial evidence supports the value of complete margin assessment in the treatment of MIS, particularly in the head and neck region.
Complete surgical excision with careful margin assessment is required to adequately treat MIS lesions, particularly given the high rate of invasive melanoma in lesions initially thought to be MIS. Mohs surgery remains the treatment of choice for all clinically ill-defined MIS.
关于莫氏手术用于原位黑色素瘤（MIS）治疗的相关文献存在争议。莫氏手术具有能够完整评估切缘的优势；然而，所采用的手术和实验室技术存在差异，使得结果比较变得困难。
回顾关于莫氏手术治疗MIS的当前文献，并评估治疗方案。
我们回顾了关于MIS传统切除切缘、经活检证实为MIS的病变中被证明存在浸润成分的比例以及莫氏手术治疗MIS的疗效的文献。
许多作者报告需要大于推荐的5毫米的手术切缘，特别是对于暴露于阳光下区域出现的MIS。此外，文献综述显示，在完整手术切除和病理检查后，近四分之一经活检证实的MIS病变被发现含有浸润性黑色素瘤。大量证据支持在MIS治疗中完整切缘评估的价值，特别是在头颈部区域。
需要进行完整的手术切除并仔细评估切缘，以充分治疗MIS病变，特别是考虑到最初被认为是MIS的病变中浸润性黑色素瘤的高发生率。对于所有临床界定不明确的MIS，莫氏手术仍然是首选治疗方法。
