Immediate versus delayed reconstruction of head and neck cutaneous melanoma

Quimby, Alexandra E.; Khalil, Diana; Johnson‐Obaseki, Stephanie

doi:10.1002/lary.27250

Cited by 10 publications

(14 citation statements)

References 18 publications

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“…This study is the largest to date reporting the incidence and risk factors for positive margins after surgical treatment of CMHN. Given the overall low incidence of positive margins (5%) in this study and others, immediate reconstruction may very well be a good option for many patients; however, variables such as patient comorbidities, clinicopathologic features, and reconstructive modality must be taken into account 1,10,11 . We recommend considering delayed reconstruction in cases of lentigo maligna/lentigo maligna melanoma, desmoplastic melanoma, spindle cell melanoma, and T3 and T4 tumors.…”

Section: Discussionmentioning

confidence: 82%

“…Given the overall low incidence of positive margins (5%) in this study and others, immediate reconstruction may very well be a good option for many patients; however, variables such as patient comorbidities, clinicopathologic features, and reconstructive modality must be taken into account. 1,10,11 We recommend considering delayed reconstruction in cases of lentigo maligna/lentigo maligna melanoma, desmoplastic melanoma, spindle cell melanoma, and T3 and T4 tumors. Patients with T4 tumors have a high likelihood ( P < .001; OR, 3.730; 95% CI, 2.677-5.197) of positive margins ( Table 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative margin assessment is not reliable in cutaneous melanoma; however, the incidence of positive margins after wide local excision of CMHN has been reported between 5% and 20% 1–9 . The relatively low incidence of positive margins after wide local excision of CMHN with appropriate margins has led some authors to conclude that immediate reconstruction is safe and oncologically sound 1,10,11 . The choice between immediate and delayed reconstruction is a risk‐benefit decision that must be made between the surgeon and the patient.…”

mentioning

confidence: 99%

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Positive Margins in Cutaneous Melanoma of the Head and Neck: Implications for Timing of Reconstruction

Namin¹,

Welby

Baker³

et al. 2020

Otolaryngol.--head neck surg.

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Objective The aim of this study is to identify clinicopathologic features associated with positive margins after surgical treatment of cutaneous melanoma of the head and neck (CMHN). Study Design Retrospective cohort study. Setting National Cancer Database. Methods A retrospective analysis of the National Cancer Database was performed of patients diagnosed with CMHN between 2004 and 2016. Univariate and multivariate analyses examining the association of clinicopathologic features with positive margins were performed via logistic regression analysis. Results A total of 101,560 patients met inclusion criteria. The incidence of positive margins was 5.0% (5128/101,560). Patients were significantly more likely to have positive margins with the following: increasing age ( P < .001; odds ratio [OR], 1.028; 95% CI, 1.026-1.031), the lip subsite ( P < .001; OR, 1.664; 95% CI, 1.286-2.154), the eyelid subsite ( P < .001; OR, 2.380; 95% CI, 1.996-2.838), the face subsite ( P < .001; OR, 1.215; 95% CI, 1.133-1.302), the lentigo maligna/lentigo maligna melanoma subtype ( P = .019; OR, 1.099; 95% CI, 1.016-1.188), the desmoplastic subtype ( P < .001; OR, 1.455; 95% CI, 1.261-1.680), the spindle cell subtype ( P = .006; OR, 1.276; 95% CI, 1.073-1.516), and advanced pT classification. Patients with male sex ( P < .001; OR, 0.733; 95% CI, 0.687-0.782) and without ulceration ( P < .001; OR, 0.803; 95% CI, 0.736-0.876) were significantly less likely to have positive margins. Conclusion The following have been identified as clinicopathologic features associated with positive margins after surgical treatment of CMHN: increasing age, female sex, the lip subsite, the eyelid subsite, the face subsite, ulceration, the lentigo maligna/lentigo maligna melanoma subtype, the desmoplastic subtype, the spindle cell subtype, and increasing pT classification.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Positive Margins in Cutaneous Melanoma of the Head and Neck: Implications for Timing of Reconstruction

Namin¹,

Welby

Baker³

et al. 2020

Otolaryngol.--head neck surg.

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“…Multiple recent studies have made blanket conclusions that immediate reconstruction is "oncologically sound" and "safe" following excision with appropriate margins based on depth for cutaneous melanoma of the head and neck. [2][3][4] The only oncological reason to delay reconstruction is to await final pathological interpretation of the margin status of the definitive excision specimen so that reexcision of positive margins could be performed more precisely without compromising the reconstruction. Excision with appropriate margins based on depth and histological subtype, with or without sentinel lymph node biopsy, remains the most frequently recommended modality of treatment by the National Comprehensive Cancer Network.…”

Section: Discussionmentioning

confidence: 99%

Considerations for Timing of Defect Reconstruction in Cutaneous Melanoma of the Head and Neck

et al. 2019

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The objective of this study is to identify the incidence and characteristics of cases with positive margins on wide local excision for cutaneous melanoma of the head and neck (CMHN) and therefore provide a potential basis for selectively delaying reconstruction pending final histological clearance of melanoma. A systematic review of English language articles was performed on studies retrieved from PubMed and Web of Science. Original investigations published between July 1999 and June 2018 reporting on margin status of CMHN wide local excision specimens were included in the review. The incidence of positive margins after definitive resection for cutaneous melanoma in the literature ranges from 6 to 20.9%. The incidence is higher in cases of advanced patient age, diagnosis by shave biopsy, lentigo maligna melanoma subtype, desmoplastic subtype, tumor thickness, and ulceration. Delayed reconstruction remains the most oncologically sound decision, allowing for interpretation of margin status on paraffin-embedded tissue sections. However, resection and the resultant defect closure in a single stage is more expedient and potentially a more efficient use of resources. The risk–benefit ratio of immediate versus delayed reconstruction must be considered for each case. The incidence of positive margins is higher in cases of advanced patient age, diagnosis by shave biopsy, lentigo maligna melanoma subtype, desmoplastic subtype, increasing tumor thickness, and the presence of ulceration; delayed reconstruction should be strongly considered in these cases.

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“…La reconstruction peut être réalisée immédiatement lors de la reprise des marges 19 . La chirurgie reconstructive de la face en oncologie est un challenge fonctionnel et esthétique.…”

Section: Technique De Reconstructionunclassified

Prise en charge par l’ORL des mélanomes cutanés cervico-faciaux

Vinckenbosch¹,

Litzistorf²,

Gaide³

et al. 2020

Revue Médicale Suisse

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Prise en charge par l'ORL des mélanomes cutanés cervico-faciauxUn quart des mélanomes cutanés se présentent au niveau de la tête et du cou. Malgré une étroite collaboration entre les services de dermatologie, oncologie, pathologie, médecine nucléaire et oto-rhino-laryngologie (ORL), la survie des patients qui présentent ce type de mélanomes reste inférieure à celle des patients ayant un mélanome d'une autre partie du corps. La morbidité d'une chirurgie cervico-faciale modifie significativement la qualité de vie. Ainsi, une expertise spécifique multidisciplinaire est nécessaire. Nous présentons ici les spécificités de la prise en charge ORL des mélanomes cervico-faciaux. ENT management of head and neck cutaneous melanomaA quarter of cutaneous melanomas occur on the head and neck. Despite close collaboration between the dermatology, oncology, pathology, nuclear medicine and otorhinolaryngology departments, the survival of patients presenting with this type of melanomas remains inferior to that of other parts of the body. The morbidity of head and neck surgery significantly alters the quality of life. Therefore, specific multidisciplinary expertise is required. We present here the specificities of ENT management.

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Immediate versus delayed reconstruction of head and neck cutaneous melanoma

Abstract: 3a. Laryngoscope, 2566-2572, 2018.

Cited by 10 publications

References 18 publications

Positive Margins in Cutaneous Melanoma of the Head and Neck: Implications for Timing of Reconstruction

Positive Margins in Cutaneous Melanoma of the Head and Neck: Implications for Timing of Reconstruction

Considerations for Timing of Defect Reconstruction in Cutaneous Melanoma of the Head and Neck

Prise en charge par l’ORL des mélanomes cutanés cervico-faciaux

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