Dermatologic surgerySurgical margins for melanoma in situ
Section snippets
Methods
A prospective database of all patients referred for Mohs excision of melanoma began in 1982, and records various patient and tumor characteristics. All patients with biopsy-proven primary melanoma in situ from March 1982 through September 2008 were considered for this study. Patients without follow-up were excluded.
All patients were treated with Mohs micrographic surgery, which was initiated by excising the biopsy site or remaining visible tumor with 3 mm of normal-appearing skin to adipose
Patient and lesion characteristics
From 1982 to 2008, 1246 consecutive patients were treated for primary melanoma in situ. In all, 174 patients (14%) had no follow-up and were excluded, usually because they were treated toward the end of the accrual period. The final cohort comprised 1072 patients with 1120 melanoma in situs. Of patients, 60% were men and the mean age was 65 years (SD 15). Most tumors were located on the face and clinical diameter was variable (Table I). Although the mean tumor diameter was 2.8 cm, 73% of all
Validity of frozen-section interpretation of melanoma
Both the low recurrence rate and the ability to achieve narrow margins (<1 cm) in 99% of patients support the accuracy of frozen sections and refute concerns that frozen sections cannot adequately detect melanoma at the margins. If our diagnostic criteria were too strict or if melanomas were not visible by frozen section, we would underdiagnose melanoma and expect a high recurrence rate. Instead, our recurrence rate was 0.3%. If our diagnostic criteria were too liberal and we excised
References (40)
- et al.
Histologic evaluation of lentigo maligna with permanent sections: implications regarding current guidelines
J Am Acad Dermatol
(2002) - et al.
Management of cutaneous malignant melanoma by dermatologists of the American Academy of Dermatology: definitive surgery for malignant melanoma
J Am Acad Dermatol
(1995) - et al.
The reliability of frozen sections in the evaluation of surgical margins for melanoma
J Am Acad Dermatol
(1991) - et al.
Surgical margins for excision of primary cutaneous melanoma
J Am Acad Dermatol
(1997) - et al.
Cutaneous head and neck melanoma treated with Mohs micrographic surgery
J Am Acad Dermatol
(2005) - et al.
A follow-up study to investigate the efficacy of initial treatment of lentigo maligna with surgical excision
Br J Plast Surg
(2002) - et al.
Guidelines of care for the management of primary cutaneous melanoma
J Am Acad Dermatol
(2011) Microinvasive lentigo maligna melanoma
J Am Acad Dermatol
(1987)- et al.
Reliability of diagnosis of melanoma in situ
Lancet
(2002) Diagnosis and treatment of early melanoma
NIH Consensus Statement
(1991 Jan 27-29)
Clinical practice guidelines for the management of melanoma in Australia and New Zealand
Mohs micrographic excision of melanoma using immunostains
Dermatol Surg
Mohs micrographic surgery for melanoma: a case series, a comparative study of immunostains, an informative case report, and a unique mapping technique
Dermatol Surg
Utility of rush paraffin-embedded tangential sections in the management of cutaneous neoplasms
Dermatol Surg
Treatment of cutaneous melanoma of the face by Mohs micrographic surgery
J Cutan Med Surg
Survey of UK current practice in the treatment of lentigo maligna
Br J Dermatol
The management of primary cutaneous melanoma in Victoria in 1996 and 2000
Med J Aust
A comparison of dermatologists’, surgeons’ and general practitioners’ surgical management of cutaneous melanoma
Br J Dermatol
Immunostaining melanoma frozen sections: the 1 hour protocol
Dermatol Surg
Melanocytes in long-standing sun-exposed skin: quantitative analysis using the MART-1 immunostain
Arch Dermatol
Cited by (151)
Excision margins for melanoma in situ on the head and neck—A single-center 10-year retrospective review of treatment with Mohs micrographic surgery
2024, Journal of the American Academy of Dermatology[Translated article] Update on Lentigo Maligna: Diagnostic Signs and Treatment
2023, Actas Dermo-SifiliograficasPermanent section margin concordance after Mohs micrographic surgery with immunohistochemistry for invasive melanoma and melanoma in situ: A retrospective dual-center analysis
2023, Journal of the American Academy of DermatologyMohs Micrographic Surgery for Melanoma: Evidence, Controversy, and a Critical Review of Excisional Margin Guidelines
2023, Dermatologic ClinicsCitation Excerpt :This option is not based on any scientific data pertaining to the WE technique and is a departure from evidence-based practice. Given the considerable evidence that a large percentage of MM extends well beyond clinical margins and that margins less than 9 mm would be expected to incompletely excise a significant percentage of tumors, this exception to the margin guidelines is concerning.24 Theoretically, in the absence of exhaustive margin evaluation, WE technique with subcentimeter margins may lead to increased incidence of incompletely excised residual melanoma.
Correlation of basal cell carcinoma subtype with histologically confirmed subclinical extension during Mohs micrographic surgery: A prospective multicenter study
2022, Journal of the American Academy of Dermatology
Funding sources: None.
Conflicts of interest: None declared.