Melanoma pp 323-335 | Cite as

Mohs Surgery for Melanoma In Situ

  • Joy Kunishige
  • John Zitelli


This chapter discusses the history and current treatment of melanoma in situ (MIS), with emphasis on the current evidence available. Removing the entire lesion is paramount, particularly as up to 67% of MIS contain invasive components. Evidence that a 1 cm margin is needed to clear 97% of melanoma in situ is presented, with even wider margins needed in some cases on the head and neck. When a 1 cm margin is anatomically impractical, Mohs surgery should be employed to attempt narrower surgical margins and achieve higher cure rates. Cure rates for wide local excision of MIS are 8–20% versus 1–2% with Mohs surgery. The use of Mohs surgery and other techniques to enable histologic evaluation of the entire peripheral margin is outlined. Advantages of Mohs surgery include tissue conservation, repair only after guaranteed clear margins, repair on the same day, and cure rates of ~99%. High cure rates are the norm, even on the head and neck and in recurrent cases. This chapter concludes with clinical scenarios that illustrate the multiple benefits of Mohs surgery for MIS.


Melanoma in situ Lentigo maligna Surgical margin Melanoma treatment Mohs surgery Staged excision Guidelines 



Funding: None

The authors have no conflicts of interest to declare.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Joy Kunishige
    • 1
  • John Zitelli
    • 2
  1. 1.Department of Plastic SurgeryZitelli & Brodland Skin Cancer Center, University of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Departments of ENT and Plastic SurgeryZitelli & Brodland Skin Cancer Center, University of Pittsburgh Medical CenterPittsburghUSA

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