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22-11-2022 | Melanoma | Original Paper

Staged melanoma excision requires larger margins for tumor clearance and results in low rates of recurrence

Authors: Jaclyn Rosenthal Himeles, Maressa C. Criscito, Nayoung Lee, Mary L. Stevenson, John A. Carucci

Published in: Archives of Dermatological Research | Issue 4/2023

Abstract

There is controversy regarding the optimal surgical modality and ideal recommended margins for treating melanoma in situ (MIS) and invasive melanoma (IM). Although wide local excision is recommended, staged excision offers excellent margin control and low recurrence rates. In this manuscript, we reviewed a 10-year experience of staged excisions for the treatment of MIS and IM. A retrospective review was performed of 130 MIS and 32 IM cases treated with staged excision from April 2012 to April 2022. Staged excision was performed on the head and neck in 102 (79%) MIS and 23 (72%) IM cases. Approximately 10% of cases required surgical margins above the current recommendations (11 (9%) MIS and 6 (19%) IM). Twenty-three (19%) MIS and 7 (22%) IM cases required more than one excision to obtain clearance. Recurrence rates among MIS and IM were 0.0% and 0.6%, respectively. Upstaging occurred in 5 (4%) MIS and 7 (22%) IM cases. Complex repairs were performed on 82 (63%) MIS and 17 (53%) IM cases. Our findings revealed that staged excision provides effective margin control and low recurrence rates. Approximately 10% of patients required margins greater than the current recommendations, leading to larger defects and more complex repairs.

Johnson TM et al (1997) Usefulness of the staged excision for lentigo maligna and lentigo maligna melanoma: the “square” procedure. J Am Acad Dermatol 37(5 Pt 1):758–764. https://doi.org/10.1016/s0190-9622(97)70114-2CrossRefPubMed

Swetter SM et al (2021) NCCN Guidelines® insights: melanoma: cutaneous, Version 2.2021. J Natl Compr Canc Netw 19(4):364–376. https://doi.org/10.6004/jnccn.2021.0018CrossRefPubMed

Ahn GS et al (2022) No Recurrence in primary invasive stage 1a and 1b melanoma and melanoma in situ treated with serial disk staged excision. Dermatol Surg 48(3):276–282. https://doi.org/10.1097/dss.0000000000003357CrossRefPubMed

Möller MG et al (2009) Surgical management of melanoma-in-situ using a staged marginal and central excision technique. Ann Surg Oncol 16(6):1526–1536. https://doi.org/10.1245/s10434-008-0239-xCrossRefPubMed

Bosbous MW, Dzwierzynski WW, Neuburg M (2009) Staged excision of lentigo maligna and lentigo maligna melanoma: a 10-year experience. Plast Reconstr Surg 124(6):1947–1955. https://doi.org/10.1097/PRS.0b013e3181bcf002CrossRefPubMed

Huilgol SC et al (2004) Surgical margins for lentigo maligna and lentigo maligna melanoma: the technique of mapped serial excision. Arch Dermatol 140(9):1087–1092. https://doi.org/10.1001/archderm.140.9.1087CrossRefPubMed

Garcia D, Eilers RE, Jiang SB (2017) Recurrence rate of melanoma in situ when treated with serial disk staged excision: a case series. J Clin Investig Dermatol. https://doi.org/10.13188/2373-1044.1000037CrossRefPubMedPubMedCentral

Moyer JS et al (2017) Efficacy of staged excision with permanent section margin control for cutaneous head and neck melanoma. JAMA Dermatol 153(3):282–288. https://doi.org/10.1001/jamadermatol.2016.4603CrossRefPubMed

Pride RLD et al (2022) Local recurrence of melanoma is higher after wide local excision versus Mohs micrographic surgery or staged excision: a systematic review and meta-analysis. Dermatol Surg 48(2):164–170. https://doi.org/10.1097/dss.0000000000003309CrossRefPubMed

10.

Walling HW et al (2007) Staged excision versus Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma. J Am Acad Dermatol 57(4):659–664. https://doi.org/10.1016/j.jaad.2007.02.011CrossRefPubMed

11.

Reynolds HH et al (2020) Efficacy of staged excision with permanent section margin control for melanoma in situ. J Am Acad Dermatol 83(4):1163–1164. https://doi.org/10.1016/j.jaad.2020.05.103CrossRefPubMed

12.

Bub JL et al (2004) Management of lentigo maligna and lentigo maligna melanoma with staged excision: a 5-year follow-up. Arch Dermatol 140(5):552–558. https://doi.org/10.1001/archderm.140.5.552CrossRefPubMed

13.

Agarwal-Antal N, Bowen GM, Gerwels JW (2002) Histologic evaluation of lentigo maligna with permanent sections: implications regarding current guidelines. J Am Acad Dermatol 47(5):743–748. https://doi.org/10.1067/mjd.2002.124085CrossRefPubMed

14.

Hill DC, Gramp AA (1999) Surgical treatment of lentigo maligna and lentigo maligna melanoma. Australas J Dermatol 40(1):25–30. https://doi.org/10.1046/j.1440-0960.1999.00311.xCrossRefPubMed

15.

Anderson KW et al (2001) Treatment of head and neck melanoma, lentigo maligna subtype: a practical surgical technique. Arch Facial Plast Surg 3(3):202–206. https://doi.org/10.1001/archfaci.3.3.202CrossRefPubMed

16.

Malhotra R et al (2003) Mapped serial excision for periocular lentigo maligna and lentigo maligna melanoma. Ophthalmology 110(10):2011–2018. https://doi.org/10.1016/s0161-6420(03)00670-5CrossRefPubMed

17.

Mahoney MH, Joseph M, Temple CL (2005) The perimeter technique for lentigo maligna: an alternative to Mohs micrographic surgery. J Surg Oncol 91(2):120–125. https://doi.org/10.1002/jso.20284CrossRefPubMed

18.

Albertini JG et al (2002) Mohs micrographic surgery for melanoma: a case series, a comparative study of immunostains, an informative case report, and a unique mapping technique. Dermatol Surg 28(8):656–665. https://doi.org/10.1046/j.1524-4725.2002.02024.xCrossRefPubMed

19.

Lee MR, Ryman WJ (2008) Treatment of lentigo maligna with total circumferential margin control using vertical and horizontal permanent sections: a retrospective study. Australas J Dermatol 49(4):196–201. https://doi.org/10.1111/j.1440-0960.2008.00468.xCrossRefPubMed

20.

Joyce KM et al (2015) An assessment of histological margins and recurrence of melanoma in situ. Plast Reconstr Surg Glob Open 3(2):e301. https://doi.org/10.1097/gox.0000000000000272CrossRefPubMedPubMedCentral

21.

de Vries K et al (2016) Recurrence rate of lentigo maligna after micrographically controlled staged surgical excision. Br J Dermatol 174(3):588–593. https://doi.org/10.1111/bjd.14325CrossRefPubMed

22.

Patel AN et al (2014) Johnson square procedure for lentigo maligna and lentigo maligna melanoma. Clin Exp Dermatol 39(5):570–576. https://doi.org/10.1111/ced.12363CrossRefPubMed

23.

Lawrence CM et al (2014) Prospective study of formalin-fixed Mohs surgery and haematoxylin and eosin stains with control contralateral biopsies for lentigo maligna: 5-year follow-up results. Br J Dermatol 171(2):298–303. https://doi.org/10.1111/bjd.12841CrossRefPubMed

24.

Gaudy-Marqueste C et al (2011) The “spaghetti technique”: an alternative to Mohs surgery or staged surgery for problematic lentiginous melanoma (lentigo maligna and acral lentiginous melanoma). J Am Acad Dermatol 64(1):113–118. https://doi.org/10.1016/j.jaad.2010.03.014CrossRefPubMed

Title: Staged melanoma excision requires larger margins for tumor clearance and results in low rates of recurrence
Authors: Jaclyn Rosenthal Himeles
Maressa C. Criscito
Nayoung Lee
Mary L. Stevenson
John A. Carucci
Publication date: 22-11-2022
Publisher: Springer Berlin Heidelberg
Keywords: Melanoma
Melanoma
Published in: Archives of Dermatological Research / Issue 4/2023
Print ISSN: 0340-3696
Electronic ISSN: 1432-069X
DOI: https://doi.org/10.1007/s00403-022-02426-z

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Staged melanoma excision requires larger margins for tumor clearance and results in low rates of recurrence

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