Skin lesions suspicious for melanoma: New Zealand excision margin guidelines in practice

Abstract

INTRODUCTION New Zealand guidelines for cutaneous melanoma management recommend excision biopsy specimens of suspected lesions have a 2 mm horizontal margin, and a deep margin into upper subcutis. AIM To assess guideline compliance of suspicious lesion biopsies taken in the community and in a hospital. METHODS Patients admitted to Waikato Hospital, Hamilton, for diagnostic or treatment melanoma surgery during the year ending February 2016 were retrospectively identified, and their demographic and biopsy characteristics examined. RESULTS In total, 140 patients had excision biopsies: 61.4% were performed outside the hospital. Biopsy data were available for 126 specimens. Mean horizontal margin was greater (P = 0.001) in hospital biopsies (4.8 mm, standard deviation (s.d.) 3.7 mm) than biopsies performed elsewhere (2.8 mm; s.d. 1.8 mm). Horizontal margins >2.0 mm occurred in 70.6% of specimens; 21.6% of ≤2.0 mm specimens had a tumour-positive margin. Subsequent wide local excision identified residual melanoma in 9.6% of specimens, which was not associated (P = 0.3) with primary horizontal margin ≤2.0 mm. Mean deep margin of hospital biopsies (6.5 mm; s.d. 2.7 mm) was greater (P < 0.001) than in other biopsies (4.1 mm; s.d. 2.7 mm). Horizontal margin >2.0 mm specimens had greater (P < 0.001) mean deep margin (5.9 mm; s.d. 2.7 mm) than specimens with horizontal margin ≤2.0 mm (mean deep margin 3.3 mm; s.d. 2.7 mm). Deep margin ≤2.0 mm (19.0%) was independently associated with the facility where biopsy was performed (P = 0.001) and horizontal margin (P < 0.001). DISCUSSION The New Zealand biopsy deep margin recommendation does not lend itself to meaningful audit. Compliance with the horizontal margin recommendation was low, but of uncertain clinical significance.

Automatic skin cancer detection in dermoscopy images by combining convolutional neural networks and texture features

“…2 A biopsy is a fundamental and efficient way for skin lesion analyzing, which is painful, time-consuming, and some drugs might influence its results. 3 Dermoscopy is a skin imaging technique providing images with more clarity by magnifying the lesions (usually x3-x10). 4 Besides, computer-aided diagnosis (CAD) can be useful in melanoma detection using dermoscopy images.…”

“…However, its early detection helps the reduction of mortality rates 2 . A biopsy is a fundamental and efficient way for skin lesion analyzing, which is painful, time‐consuming, and some drugs might influence its results 3 . Dermoscopy is a skin imaging technique providing images with more clarity by magnifying the lesions (usually x3‐x10) 4 .…”

Excision Margin and Survival in Patients with High-Risk, Primary Cutaneous Melanoma: A Retrospective Study Based on Surveillance Epidemiology and End Result (SEER) Database

“…The results revealed that there was no significant difference in melanoma-specific survival or overall survival between groups with 2-cm and 4-cm excision margins, for patients with localized CM thicker than 2 mm [11, 16, 17]. This research led to the present guidelines, including the National Comprehensive Cancer Network (NCCN), American Academy of Dermatology (AAD), and National Institute for Health and Care Excellence (NICE), which recommended the 2-cm margin for primary CM with a thickness of >2 mm [18, 19].…”

From the Editor: Reading, writing and research impact

“…11,12 Brian and Jameson include the hospital side of the melanoma story, concluding that New Zealand guidelines for melanoma excision biopsy need revision so that they provide more clinically meaningful measures that clinicians can use to audit their care. 13 Further relating to the practical use of guidelines, Reyneke, Jaye and Stokes examine the process of accepting and using care pathways in the Western Bay of Plenty. 14 We also have an array of papers about health care services.…”