Melanoma Upstaging During Mohs Micrographic Surgery: A Single-Center 12-Year Experience.

StudyDermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]· Sep 2026

Melanoma Upstaging During Mohs Micrographic Surgery: A Single-Center 12-Year Experience.

Sujitha Yadlapati, Maria Melendez-Gonzalez, Olufolakemi Awe … Bradley G Merritt

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Dermatologic SurgeryStudyQ2IF 1.2

Melanoma upstaging on Mohs debulking specimens is uncommon, occurring in a small minority of cases in a retrospective single-surgeon series.

Melanoma Upstaging During Mohs Micrographic Surgery: A Single-Center 12-Year Experience.

Sujitha Yadlapati … Bradley G Merritt

Dermatologic surgery · Sep 2026 · Q2 in Surgery

Background

Mohs micrographic surgery (mohs micrographic surgery) with MART-1/Melan-A immunostaining is increasingly used for melanoma in situ and invasive melanoma.

Purpose

To determine the frequency of melanoma upstaging on debulking specimens and compare routine versus selective, frozen section-guided submission.

Methods

Single-center retrospective review of all cutaneous melanomas treated with mohs micrographic surgery by one surgeon (2010-2022).

n = 25 cases

Results

of melanomas had a debulking specimen showing deeper invasion than first seen, so upstaging was rare

2.5%

Routine era

1.5%

Selective era

More results

Overall upstaging was 2.5% (routine) versus 1.5% (selective) (p = .138).

In the selective era, debulking specimens were submitted in only 25 cases, of which 21 (84.0%) showed upstaging, reflecting strong concordance between intraoperative frozen section suspicion and permanent section findings.

More results

Most upstaged tumors were low risk (77.8% T1a-T1b); only 22.2% reached T2a or higher.

“

Conclusion

Melanoma upstaging during mohs micrographic surgery is uncommon and usually low risk, supporting a selective, individualized approach to permanent section submission guided by intraoperative frozen section findings.

Melanoma Upstaging During Mohs Micrographic Surgery: A Single-Center 12-Year Experience.

Melanoma Upstaging During Mohs Micrographic Surgery: A Single-Center 12-Year Experience.

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