Beaulieu Derek, Fathi Ramin, Srivastava Divya, Nijhawan Rajiv I
Tufts University School of Medicine, Boston, MA.
Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Clin Cosmet Investig Dermatol. 2018 Jun 20;11:309-320. doi: 10.2147/CCID.S137513. eCollection 2018.
Mohs micrographic surgery (MMS), a specialized surgical excision technique used primarily in the treatment of skin cancers, is tissue sparing and provides optimal margin control through evaluation of 100% of both the peripheral and deep margin. The use of MMS for the treatment of malignant melanoma (MM) and melanoma in situ (MIS) has been slow in gaining the same widespread acceptance that it has for keratinocyte carcinomas despite its cost-effectiveness and the growing body of evidence demonstrating similar or improved cure rates to standard wide local excision. However, modern advances in immunohistochemical staining have continued to greatly enhance the ability of Mohs surgeons to interpret MMS frozen sections of melanoma specimens - the primary concern of most opponents of MMS for melanoma. These advances, coupled with an increased recognition by professional organizations of the utility of MMS in treating MM and MIS, have led to a rise in the use of MMS for melanoma in recent years. Given the expanding role of MMS in the treatment of cutaneous melanoma, this manuscript will describe how MMS is performed, discuss the rationale and current evidence regarding the use of MMS for MM and MIS, review the immunohistochemical stains currently available for use in MMS, and consider special situations and future directions in this area of growing interest.
莫氏显微外科手术（MMS）是一种主要用于治疗皮肤癌的专业手术切除技术，它能够保留组织，并通过对100%的周边和深部切缘进行评估来实现最佳的切缘控制。尽管MMS具有成本效益，且越来越多的证据表明其治愈率与标准的广泛局部切除相似或更高，但与用于治疗角质形成细胞癌相比，MMS用于治疗恶性黑色素瘤（MM）和原位黑色素瘤（MIS）的应用在获得广泛认可方面进展缓慢。然而，免疫组织化学染色方面的现代进展继续极大地提高了莫氏外科医生解读黑色素瘤标本MMS冰冻切片的能力——这是大多数反对将MMS用于黑色素瘤治疗的人主要关注的问题。这些进展，再加上专业组织对MMS在治疗MM和MIS中的效用的认可度提高，导致近年来MMS在黑色素瘤治疗中的应用有所增加。鉴于MMS在皮肤黑色素瘤治疗中的作用不断扩大，本文将描述MMS的操作方法，讨论使用MMS治疗MM和MIS的基本原理和当前证据，回顾目前可用于MMS的免疫组织化学染色，并考虑这一日益受关注领域的特殊情况和未来方向。
