Predicting positive margins in resection of cutaneous melanoma of the head and neck

Abstract

In this large series of head and neck melanomas excised using National Comprehensive Cancer Network-recommended margins, histopathologic margin status could be predicted based on age but not on lesion characteristics. This finding is surprising given the published data showing that melanoma in situ has a higher rate of positive margin compared to subtypes of invasive melanoma. It reinforces the need for delaying reconstruction until margins are clear or performing reconstruction at a time of resection that does not compromise the ability to resect margins further (e.g., skin graft).

Correlation Between Appropriate Use Criteria and the Frequency of Subclinical Spread or Reconstruction With a Flap or Graft for Melanomas Treated With Mohs Surgery With Melanoma Antigen Recognized by T Cells 1 Immunostaining

“…Melanomas with indistinct clinical margins are at increased risk for local recurrence or positive pathologic margins with conventional excision. (2, 3) If reconstruction is performed immediately after conventional excision and prior to confirming clear margins, patients may require additional excisions and more complex reconstruction procedures.…”

Immediate versus delayed reconstruction of head and neck cutaneous melanoma

“…Similarly, relatively fewer published studies exist directly examining outcomes following delayed as compared to immediate reconstruction. The study by Christophel et al examines outcomes of delayed reconstruction in a large cohort of patients (n = 412); however, it represents data from a single institution, which limits generalizability of these results . Although our risk of bias assessment demonstrated a low overall degree of bias in our included studies, it should be noted that some studies included small numbers of patients who presented with locally recurrent melanoma, which has the potential to skew the reported rates of positive margins/local recurrence following resection and reconstruction.…”

Frequency of and risk factors for tumor upstaging after wide local excision of primary cutaneous melanoma

“…However, excisional biopsies were less likely to have negative margins (both deep and lateral) for melanomas on the head, neck, hands, feet, genitals, or pretibial leg (26%, 8/31) versus those on the trunk and proximal extremities (54%, 54/100). The increased risk for upstaging, whatever the method of biopsy, adds to the well-documented challenges of positive margins [30][31][32][33] and local recurrence 16,[33][34][35][36][37][38][39][40][41][42][43][44][45][46] after wide local excision of melanomas on the head, neck, hands, feet, genitals, or pretibial leg. An explanation for the significance of the risk factors old age (OR 1.03, 95% CI 1.01-1.06, P = .002) and non-LM histopathologic subtype (OR 0.28, 95% CI 0.12-0.64, P = .002) is unclear.…”