Specialty site melanomas on the head and neck, hands and feet, genitalia, and pretibial leg have higher rates of surgical complications after conventional excision with postoperative margin assessment (CE-POMA) compared with trunk and proximal extremity melanomas. The rule of 10s describes complication rates after CE-POMA of specialty site melanomas: ∼10% risk for upstaging, ∼10% risk for positive excision margins, ∼10% risk for local recurrence, and ∼10-fold increased likelihood of reconstruction with a flap or graft. Trunk and proximal extremity melanomas encounter these complications at a lower rate, according to the rule of 2s. Mohs micrographic surgery (MMS) with frozen section melanocytic immunostains (MMS-I) and slow Mohs with paraffin sections decrease complications of surgery of specialty site melanomas by detecting upstaging and confirming complete tumor removal with comprehensive microscopic margin assessment before reconstruction. This article reviews information important for counseling melanoma patients about surgical treatment options and for developing consensus guidelines with clear indications for MMS-I or slow Mohs.

与躯干和四肢近端黑色素瘤相比，头颈部、手足、生殖器和胫前小腿的特殊部位黑色素瘤在常规切除术后切缘评估 (CE-POMA) 后的手术并发症发生率更高。10s 规则描述了特殊部位黑色素瘤 CE-POMA 后的并发症发生率：~10% 的升期风险，~10% 的阳性切除边缘风险，~10% 的局部复发风险，以及~10 倍的重建可能性增加皮瓣或移植物。根据 2s 规则，躯干和四肢近端黑色素瘤发生这些并发症的几率较低。使用冰冻切片黑色素细胞免疫染色 (MMS-I) 的 Mohs 显微手术 (MMS) 和使用石蜡切片的慢速 Mohs 通过在重建前检测分期并通过全面的显微切缘评估确认完全切除肿瘤来降低专科部位黑色素瘤手术的并发症。本文回顾了重要的信息，这些信息对于向黑色素瘤患者咨询手术治疗选择以及制定明确的 MMS-I 或慢莫氏综合征指征的共识指南非常重要。