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Staged marginal evaluation of melanoma in situ (MIS) is performed in order to avoid reconstruction on positive margins. Contoured marginal excision (CME) is an excision of a 2mm wide strip of normal-appearing skin taken 5mm from the visible tumor periphery. If positive, a new CME is excised; the tumor is resected once negative margins are confirmed. The purpose of this study is to report our experience using this technique for the treatment of head/neck MIS. Clinicopathological data were abstracted for all patients who underwent staged CME followed by central tumor resection for head/neck MIS; patients with invasive melanoma were excluded. Statistical analyses included χ2 and t-test. Overall, 127 patients with MIS were identified. 56% were male; the average age was 68 years. The median number of CME procedures per patient was 1 (range 1 to 4). 23% of patients required more than one CME procedure to achieve negative margins. Local recurrence occurred in 3/127 patients after a median follow-up of 5 months. Patients requiring multiple CME procedures were more likely to experience local recurrence (P<0.001). In conclusion, this technique is an effective method to avoid reconstruction on positive MIS margins with high local disease control rates.

Nevus spilus is a melanocytic neoplasm characterized by a tan macular background punctuated by multiple hyperpigmented macules or papules that represent various types of nevi. These include junctional and compound nevi, Spitz nevi, and rarely blue nevi. We report a unique case of widespread, multiple nevi spili giving rise to agminated Spitz nevi and congenital-pattern compound nevi. We performed genetic analysis to further characterize the mutational profile of this rare entity.