Immunostained Frozen Sections Vs Traditional Permanent Paraffin Sections for Lentigo Maligna Treated With Mohs Micrographic Surgery

Punchihewa, Nisal; Odhavji, Sonya; Upjohn, Edward; Bekhor, Philip

doi:10.1097/dss.0000000000003280

Cited by 3 publications

(3 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nonetheless, the use of immunostained frozen sections does not fully negate the risk of overtreatment of melanocytic hyperplasia using en face sectioning, compared with conventional vertical cross sections towards the tissue edge 76 . This issue is further highlighted in the study by Punchihewa et al 9 where there was a 13% disagreement compared with traditional permanent paraffin‐embedded sections for LM treated by MMS. Finally, the follow‐up period of classic MMS, slow‐MMS, and to a lesser extent SE with complete margin assessment, was limited or in some studies not reported on.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, MMS is not only limited by requiring extensive training, but more importantly, the use of frozen sections is not universally accepted in the treatment of melanocytic lesions as it can result in artefactual and fixational changes in the excisional specimens. 9 To circumvent this issue (rushed) permanent paraffin-embedded sections (i.e. 'Slow' Mohs) or frozen sections with immunohistochemistry (IHC) staining are increasingly being used.…”

Section: Introductionmentioning

confidence: 99%

“…Mohs' micrographic surgery (MMS) allows intra‐operational en face assessment of the surgical margins. Unfortunately, MMS is not only limited by requiring extensive training, but more importantly, the use of frozen sections is not universally accepted in the treatment of melanocytic lesions as it can result in artefactual and fixational changes in the excisional specimens 9 . To circumvent this issue (rushed) permanent paraffin‐embedded sections (i.e.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Lentigo maligna (melanoma): A systematic review and meta‐analysis on surgical techniques and presurgical mapping by reflectance confocal microscopy

Elshot

Tio

With

et al. 2023

Acad Dermatol Venereol

View full text Add to dashboard Cite

Because of an increased risk of local recurrence following surgical treatment of lentigo maligna (melanoma) (LM/LMM), the optimal surgical technique is still a matter of debate. We aimed to evaluate the effect of different surgical techniques and reflectance confocal microscopy (RCM) on local recurrence and survival outcomes. We searched MEDLINE, Embase and PubMed databases through 20 May 2022. Randomized and observational studies with ≥10 lesions were eligible for inclusion. Bias assessment was performed using the Methodological Index for Non‐Randomized Studies instrument. Meta‐analysis was performed for local recurrence, as there were insufficient events for the other clinical outcomes. We included 41 studies with 5059 LM and 1271 LMM. Surgical techniques included wide local excision (WLE) (n = 1355), staged excision (n = 2442) and Mohs' micrographic surgery (MMS) (n = 2909). Six studies included RCM. The guideline‐recommended margin was insufficient in 21.6%–44.6% of LM/LMM. Local recurrence rate was lowest for patients treated by MMS combined with immunohistochemistry (<1%; 95% CI, 0.3%–1.9%), and highest for WLE (13%; 95% CI, 7.2%–21.6%). The mean follow‐up varied from 27 to 63 months depending on surgical technique with moderate to high heterogeneity for MMS and WLE. Handheld‐RCM decreased both the rate of positive histological margins (p < 0.0001) and necessary surgical stages (p < 0.0001). The majority of regional (17/25) and distant (34/43) recurrences occurred in patients treated by WLE. Melanoma‐associated mortality was low (1.5%; 32/2107), and more patients died due to unrelated causes (6.7%; 107/1608). This systematic review shows a clear reduction in local recurrences using microscopically controlled surgical techniques over WLE. The use of HH‐RCM showed a trend in the reduction in incomplete resections and local recurrences even when used with WLE. Due to selection bias, heterogeneity, low prevalence of stage III/IV disease and limited survival data, it was not possible to determine the effect of the different surgical techniques on survival outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Lentigo maligna (melanoma): A systematic review and meta‐analysis on surgical techniques and presurgical mapping by reflectance confocal microscopy

Elshot

Tio

With

et al. 2023

Acad Dermatol Venereol

View full text Add to dashboard Cite

show abstract

Lentigo maligna: a review

Karponis,

Stratigos,

Joshy

et al. 2023

Clinical and Experimental Dermatology

View full text Add to dashboard Cite

Lentigo maligna (LM) is a melanoma in situ with distinct clinical features and histology. It commonly affects males after the sixth decade of life. Incidence rates of LM have increased based on early 21st century data from different countries, however data are suboptimal. Data from England show a plateauing crude incidence between 2013-2019. By comparison, invasive melanoma and other types of melanoma in situ commonly appears in younger age groups (median age 58 and 67 years old, respectively) and incidence is rising. The most important risk factors for LM include fair skin and cumulative ultraviolet solar radiation exposure. Although LM is limited to the epidermis and connected skin adnexa, it may progress to invasive lentigo maligna melanoma. The reported rate of malignant progression varies, reflecting a challenge for LM epidemiology research, as often lesions are removed on diagnosis. LM poses a challenge in diagnosis and management. While it can be diagnosed clinically or dermoscopically, the gold standard remains histopathological assessment of biopsied skin tissue. Reflectance confocal microscopy allows for better appreciation of the complexity of LM at a cellular level, often progressing beyond clinical margins. Management of LM may involve Mohs micrographic surgery or excision, although recurrence may occur even with 5 mm clinical margins. Imiquimod cream may be effective, but incomplete treatment and recurrence has been reported. Conservative management with observation or radiotherapy may be used in selected cases. 5-year net survival rates are excellent. This paper reviews the natural history, epidemiology, aetiology, pathogenesis, diagnosis and management of LM.

show abstract