Table 1. Included studies on slow Mohs surgery for melanoma.

MMS: Mohs micrographic surgery; mMMS: modified Mohs micrographic surgery; WLE: wide local excision; SMS: slow Mohs surgery; MIS: melanoma in situ

Authors and reference	Size of the study	Treatment details	Results	Conclusion
Seo et al. 2019, [11]	A total of 210 patients underwent slow MMS (n = 66) or wide local excision (n = 144) for melanomas	Slow MMS was used for melanomas in anatomically complex locations and for high-risk lesions.	The most frequently reported type of melanoma in patients was acral melanoma, followed by head and neck melanomas and trunk melanomas. Local recurrence of acral melanomas was less frequent after slow MMS (3.7%) as compared to WLE (10.7%). These findings were supported by statistical analysis (p=.002).	mMMS is a successful treatment option for melanoma, supported by low rates of local recurrence and high melanoma-specific survival
Then et al. 2009. [12]	A total of 14 patients with periocular melanoma	Fourteen patients underwent a total of 14 SMS to remove various melanoma lesions and tumors.	The procedures addressed eight lentigo maligna melanomas, or nodular melanoma, one superficial spreading melanoma, four lentigo maligna tumors, 12 primary melanomas, and two recurrent melanomas.  The most common site of these lesions/tumors was the lower eyelid, accounting for eight out of the 14 cases (57.1%). Breslow thickness ranged from 0.27 mm to 1.70 mm, with four cases being less than 0.76 mm and one case exceeding 1.5 mm. Five cases had a Clark level of II or greater.	SMS using en-face sections achieved comparable early cure rates to other margin-controlled excision techniques previously reported in the literature. Utilizing narrow margins of excision during slow Mohs can maximize tissue preservation without negatively impacting patient outcomes.
Zhang et al. 2023, [13]	A total of 10 patients were enrolled in the study. Each patient received the conventional SMS, and clinic follow-ups were held on a regular basis.	Ten patients underwent SMS to treat nodular and multifocal invasive squamous cell carcinoma	Two patients required one stage of Mohs surgery, while seven patients needed two stages. One patient underwent seven stages of Mohs surgery. The resection margins after surgery ranged from 5 to 25 mm. No severe complications were reported from the Mohs procedures.	SMS is a valuable surgical method to treat nail apparatus melanoma in situ that preserves digit function and can be well tolerated by patients.
Osemwota et al. 2021, [14]	One patient, a 68-year-old man with a history of synchronous melanoma on the back	The patient was referred to the dermatologic surgery clinic. SMS was utilized to remove the primary tumor, starting with about 4-mm margins	After accurate staging, the approach to treating conjunctival melanoma depends on the size of the lesion. Surgical removal is typically the initial treatment option. Depending on the tumor stage, supplementary therapies such as cryotherapy, topical chemotherapy, radiation therapy, enucleation, or exenteration may be considered.	SMS could be beneficial in managing certain cases of periocular melanoma by preserving tissue, reducing morbidity, and potentially lowering the risks of recurrence, metastasis, and mortality.
Bladen  et al. 2023, [15]	A total of 22 patients treated for eyelid melanoma	The tumor removal procedure involved creating en-face horizontal sections of the specimen using rush paraffin embedding and delayed reconstruction of the defect (SMS).	A total of 22 cases were seen with a survival rate of 91%. Seven cases presented with MIS. Of the invasive melanomas, there were eight cases of lentigo maligna melanoma, four nodular melanomas, two amelanotic melanomas, and one desmoplastic melanoma. The mean excision margin for MIS was 3 mm (range, 2-5 mm). For invasive melanomas, the mean excision margin was 5 mm (range, 2-10 mm). Further excisions were performed in nine cases (41%), of which two went on to recur locally. The overall local recurrence rate was 36%.	The survival rates were consistent with the overall 90% survival rate reported for melanoma in the UK. Prescribed excision margins cannot be uniformly applied around the eye region. A margin-controlled excision technique using a delayed repair approach is recommended. Evidence supporting the use of vitamin D therapy in melanoma needs to be implemented in clinical practice. The study also found cases where MIS progressed to invasive melanoma, supporting the practice of excising MIS rather than just monitoring it.
Hilari et al. 2012, [16]	A total of 23 patients with lentigo maligna of the head	Patients with lentigo maligna of the head treated definitively with conventional surgical excision or SMS	Wider surgical margins of greater than 0.5 cm were required in 69.2% of cases involving recurrent lentigo maligna and 26.5% of cases involving primary lentigo maligna. Factors that increased the likelihood of needing wider margins included a history of prior treatment that could have obscured the clinical border of the lesion, lesions located in the central face region, and skin phototypes III-V.	This technique is well-suited for evaluating lesions that are recurrent in nature or have borders that are difficult to delineate clinically, as well as those where underlying subclinical spread may be possible.