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BACKGROUND Microscopic evaluation of the entire surgical margin during excision of cutaneous malignancies results in the highest rates of complete excision and lowest rates of true local scar recurrence. Few studies demonstrate the outcomes of Mohs micrographic surgery specifically for invasive melanoma of the trunk and proximal extremities. OBJECTIVE To evaluate the long-term efficacy of Mohs micrographic surgery for invasive melanoma of the trunk and proximal extremities, including true local scar recurrence rate, distant recurrence-free survival and disease-specific survival. METHODS Prospectively collected study of 1416 cases of invasive melanoma of the trunk and proximal extremities was performed in order to evaluate long-term outcomes. RESULTS True local scar recurrences occurred in our cohort at a rate of 0.14% (2 of 1416), after a mean follow-up period of 75 months and were not associated with tumor depth. The rate of rate of satellite/in-transit recurrences, as well as disease-specific survival stratified by tumor thickness, were superior to historical controls. LIMITATIONS We used a nonrandomized, single-institution, and retrospective design. CONCLUSIONS Mohs micrographic surgery of primary cutaneous invasive melanoma on the trunk and proximal extremities resulted in local control of 99.86% of tumors and an overall disease-specific death superior to wide local excision.