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Background: There are limited published data comparing wide local excision (WLE) with Mohs micrographic surgery (MMS) for the treatment of melanoma., Objective: To describe a novel treatment algorithm for the surgical management of head and neck melanoma and compare rates of local recurrence for tumors treated with either MMS using immunohistochemistry or WLE., Materials and Methods: A 10-year retrospective chart review including all in situ and invasive melanomas of the head and neck treated at one institution from January 2004 to June 2013., Results: Among 388 patients with melanoma, MMS was associated with decreased rates of local recurrence (p = .0012). However, patient and tumor characteristics varied significantly, and WLE subgroup was largely composed of higher stage and risk tumors. Subgroup analysis found that patients with in situ or thin invasive tumors (<0.8 mm) treated with MMS had improved local recurrence outcomes (p = .0049), despite more frequent tumor location on high risk anatomic sites (e.g., central face). In addition, MMS was associated with a favorable delay in time to local recurrence among in situ tumors (HR = 31.8; p = .0148)., Conclusion: These findings further support the use of MMS for treatment of melanoma of the head and neck and help to validate our proposed clinical decision tree.

Although Mohs micrographic surgery is the standard of care for large, aggressive or recurrent non-melanoma skin cancers of the head and neck, tumours that involve deep underlying structures (including bone, parotid gland and named nerves) are impractical for extirpation under local anaesthesia. Such cases are often referred to a head and neck surgeon, who typically relies on intraoperative frozen section analysis of the peripheral cutaneous margin. Here we describe the use of the Mohs moat technique as part of a collaborative approach for the treatment of aggressive and deeply invasive basal cell carcinoma that allows an analysis of the complete peripheral cutaneous margin and results in decreased operating room and general anaesthesia time., (© 2013 The Authors. Australasian Journal of Dermatology © 2013 The Australasian College of Dermatologists.)

Purpose: To evaluate the significance of the new TotalCare Cancer Center at Los Alamitos Medical Center during its first 6 months of operation. This study evaluates the short-term impact that the center has had on patient caseload in the areas of infusion and radiation oncology., Methods: Two 6-month time blocks were evaluated using the cancer registry database. Cases were reviewed to determine the number of patients that received chemotherapy and radiation therapy at Los Alamitos Medical Center prior to and directly after the initiation of the TotalCare Cancer Center to determine if the initial goals laid out by the administration were met., Results: The same number of patients received chemotherapy at the hospital prior to and directly after the center was opened and few patients received radiation therapy in the first 6 months after the center was opened., Conclusion: The TotalCare Cancer Center did not appear to have the desired impact on caseload as was desired by the administration within the first 6 months of operation. However, overall caseload did increase over that time period, concluding that there may be a lag in overall affect of the new center.