No Recurrence in Primary Invasive Stage 1a and 1b Melanoma and Melanoma in Situ Treated With Serial Disk Staged Excision

Abstract

BACKGROUND Optimal surgical treatment modality for invasive melanoma (IM) and melanoma in situ (MIS) has been debated with proponents for standard wide local excision (WLE), serial disk staged excision, and Mohs micrographic surgery. OBJECTIVE The purpose of this study is to identify the recurrence rates and surgical margins of invasive stage 1 melanoma and MIS lesions using serial disk staged excision technique with rush permanent processing and "bread loafing" microscopic analysis. MATERIALS AND METHODS Recurrence rates and surgical margins of 63 IM and 207 MIS at the University of California Dermatology Surgery Unit were retrospectively reviewed. RESULTS No recurrences were observed with average follow-up of 34 and 36 months for IM and MIS, respectively (range, 10-92 months). Average surgical margins were 19.8 mm (SD 9.7) for IM and 12.1 mm (SD 12.2) for MIS. CONCLUSION This SSE technique for the treatment of IM and MIS is comparable in efficacy to other SSE techniques, and it offers physicians a simple and accessible alternative to WLE and MMS.

Intraoperative Immunohistochemistry During Mohs Micrographic Surgery and Staged Excision Decreases Local Recurrence Rates for Invasive Cutaneous Melanoma: A Systematic Review and Meta-Analysis

“…Table 1 summarizes the data for the 57 included studies; 6,9,10,27–81 all were retrospective or prospective cohort studies. The studies included a total of 12,043 patients, including 12,590 cases of melanoma encompassing 67.7% melanoma in situ (MIS), 31.6% invasive melanoma, and 0.7% tumors of unreported invasion status; 6,796 (54.0%) of tumors were located on the head and neck, whereas 2,460 (19.5%) did not have the anatomic location reported.…”

“…In all, 23 studies 28,29,32,33,35–38,44,52–55,63,64,68,69,71,72,76–79 used H&E staining alone encompassing 2,851 patients with 2,894 tumors with an average reported Breslow depth of 0.58 mm for invasive tumors; 17 studies 31,34,39–43,46,48–50,52,54,57,60,74,75 used IHC staining for all cases encompassing 3,835 patients with 3,907 tumors with an average reported Breslow depth of 0.84 mm for invasive tumors; 19 studies 6,9,27,30,45,47,51,56,58,59,61,62,65–67,70,73,80,81 included a mix of patients treated with either H&E alone or with IHC encompassing 5,357 patients with 5,789 tumors with an average reported Breslow depth of 1.0 mm for invasive tumors. Two studies included patient subsets treated with H&E alone and IHC alone, so the total sum of articles included in this meta analysis is 57.…”

“…In all, 23 studies 28,29,32,33,[35][36][37][38]44,[52][53][54][55]63,64,68,69,71,72,[76][77][78][79] used H&E staining alone encompassing 2,851 patients with 2,894 tumors with an average reported Breslow depth of 0.58 mm for invasive tumors; 17 studies 31,34,[39][40][41][42][43]46,[48][49][50]52,54,57,60,74,75 used IHC staining for all cases encompassing 3,835 patients with 3,907 tumors with an average reported Breslow depth of 0.84 mm for invasive tumors; 19 studies 6,9,27,30,45,47,51,56,58,…”