MOHS MICROGRAPHIC SURGERY USING HMB-45 FOR A RECURRENT ACRAL MELANOMA

BACKGROUND. Acral melanomas are uncommon. Due to the thick overlying s tratum corneum, accurate estimation of margins is difficult for minima lly pigmented or amelanotic melanomas on the palm or sole. OBJECTIVE. To describe the use of Mohs micrographic surgery using frozen sections and HMB-45 immunostaining in the treatment of a multiply recurrent ac ral melanoma that had failed both standard surgery and Mohs surgery. M ETHODS; The melanoma was excised by Mohs technique, and the margins we re checked by frozen section and HMB-45 immunostaining. RESULTS. The m elanoma teas completely excised in 11 stages, resulting in a defect th at covered much of the plantar surfaces of the ball of the left foot, great, second, third,fourth, and fifth toes. No recurrence has been no ted in 22 months of follow-up. CONCLUSIONS. HMB-45 immunostaining is a very valuable adjunct to examination of surgical margins for melanoma , particularly when combined with such histologic features as clusteri ng of cells, melanocyte position within the epidermis, and cytologic a typia. (C) 1998 by the American Society for Dermatologic Surgery, Inc.