Excision Margins For Melanoma Research Articles

Excision margins for melanoma in situ on the head and neck—A single-center 10-year retrospective review of treatment with Mohs micrographic surgery

Although current guidelines recommend a 5mm surgical margin for the excision of melanoma in situ (MIS), increasing evidence has shown this may be suboptimal to achieve tumor clearance. To evaluate margins required for optimal cure rates with excision of MIS on the head and neck and investigate tumor and/or patient factors in those requiring >5mm margins to achieve tumor clearance. A retrospective chart review was performed on 846 (807 primary and 39 recurrent) MIS cases on the head and neck treated in the authors' dermatologic surgery department over a 126-month (10.5year) period. Sixty-two percent were cleared with 5mm margins. A total of 15mm margins were required to achieve a 97% clearance rate. Difference in clearance rate between margin thresholds was significant (P<.001). Tumor location on the cheek and larger preoperative size correlated with requiring >5mm margins to achieve tumor clearance (P=.006 and P=.001, respectively). This is a single-center retrospective study which relies on accurate documentation of clinical data. This study demonstrates that MIS on the head and neck often requires margins >5mm margins to achieve tumor clearance. When Mohs micrographic surgery is not possible, excision margins of ≥10mm are likely necessary for head and neck tumors.

Excision margins for melanomas: how wide is enough?

Excision margins for melanomas: how wide is enough?

Early melanoma with halo eczema (Meyerson's phenomenon)

We present a case of a 49-year-old man who presented with a solitary atypical pigmented lesion with a surrounding halo of dermatitis. Dermoscopy showed a pigment network at the periphery with areas of scar-like depigmentation, negative pigment network and erythema. The lesion was treated preoperatively with a potent topical corticosteroid resulting in a reduction of inflammation. Histology showed an early Clark level 1 melanoma arising within a severely dysplastic compound melanocytic naevus. There was an adjacent perivascular chronic inflammatory cell infiltrate with occasional eosinophils. Minimal, though definite spongiosis with parakeratosis was also present. The scar was subsequently re-excised achieving appropriate excision margins for melanoma in situ. Six months later, there was recurrence of dermatitis at the scar with no evidence of recurrent melanoma. To our knowledge, melanoma with Meyerson phenomenon has not been reported in the literature. This case highlights that all lesions should be evaluated on clinical and dermoscopic grounds regardless of the presence or absence of eczema. Our case adds yet another entity that may display Meyerson phenomenon and consequently a halo of eczema cannot be considered a reassuring sign when evaluating melanocytic lesions.

A policy for selective and reducing excision margins for melanoma

A policy for selective and reducing excision margins for melanoma

Excision Margins for Melanoma in Awkward Places Like the Eyelid

To the Editor. —I read with interest a recently published National Institutes of Health (NIH) consensus statement that identified several clinical directions for future research on the diagnosis and treatment of early melanoma of the skin. 1 These included the determination of optimal margins for primary melanomas deeper than 1 mm and the investigation of alternative therapies for primary melanomas in which normal tissue conservation is critical. One of these (unmentioned) special locations is the eyelid, where consensus panel recommendations of excision margins (0.5 cm for melanoma in situ and 1 cm for thin invasive melanoma) represent radical sacrifices of eyelid tissue. From the few reported series in the ophthalmologic literature, 2 it appears that cutaneous melanoma of the eyelid is rare but carries a relatively favorable prognosis in comparison with cutaneous melanomas of other sites. These differences in prognosis and unique aspects of eyelid anatomy may have important treatment

Excision margins for melanoma in awkward places like the eyelid

Excision margins for melanoma in awkward places like the eyelid

Excision Margins for Melanoma in Awkward Places Like the Eyelid-Reply

In Reply. —We respond to Dr Reifler's letter from two perspectives—that of the chair of the NIH Consensus Conference on the diagnosis and treatment of early melanoma (L.A.G.), and that of a dermatologic surgeon (M.B.). We speak for ourselves and not for the consensus panel. The 1-cm margins for melanoma excision must be used thoughtfully. The dimensions are a guide rather than an absolute rule in regions in which there are functioning vital structures and where there are important cosmetic considerations. Therefore, in such sites as the eyelid, lip, glands, and penis, smaller margins may be used, but in such circumstances careful histological checking of the margins for tumor are imperative. Mohs' surgery has been suggested for those lesions although the interpretation of the histologic margins in those instances can be difficult. The behavior of melanoma has been studied in different anatomical sites, and although special behavior has been suggested