Melanoma in Situ

  • Katherine T. Steele
  • Christopher J. MillerEmail author


Melanoma in situ, defined as melanoma entirely restricted to the epidermis and its accompanying epithelial adnexal structures, is increasing in incidence. Detection and treatment of MIS is important, due to the risk of occult invasion or progression to invasive melanoma. There is a lack of high-quality evidence regarding the optimal treatments for MIS. The majority of MIS in the United States are treated with surgical modalities including conventional wide local excision, staged excision, and Mohs micrographic surgery (MMS). Conventional wide local excision effectively treats most well-defined primary melanomas on the trunk and extremities, but the technique has greater than a 10% risk of positive margins and local recurrence for MIS on the head, neck, hands, feet, and pretibial leg. Staged excision with microscopic margin evaluation via formalin-fixed paraffin-embedded sections and MMS achieve local clearance rates of > 98% for in situ and invasive melanomas arising in chronically sun-damaged skin. Anatomic location and history of previous treatment identify melanomas that may benefit from staged excision or MMS to detect subclinical spread of tumor prior to reconstruction.


Local Excision Head Neck Staged excision Surgery 


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of DermatologyHospital of the University of PennsylvaniaPhiladelphiaUSA

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