Skin Mapping With Punch Biopsies for Defining Margins in Melanoma: When You Don’t Know How Far to Go

Abstract

Background-Wide local excision of primary cutaneous melanoma usually provides clear margins and excellent local control. Nonclassical presentations of cutaneous melanoma, however, can challenge this treatment algorithm. Specifically, persistent melanoma-in-situ (MIS) at the margin not suspected clinically makes planning definitive wide local excision more difficult. We hypothesized that the use of punch biopsies as a mapping tool would allow us to obtain clear margins in these challenging cases.

Mapping biopsy with punch biopsies to determine surgical margin in extramammary Paget's disease

“…Mapping biopsy is a preoperative method to identify the histological margin in order to avoid unnecessary radical surgical resection and reduce the recurrence rate. The procedure has various terms, such as punch biopsy mapping, multiple scouting biopsies and skin mapping with punch biopsies . Mapping biopsy has been advocated for many tumors that have an unpredictable amount of subclinical spread, such as perianal Bowen's disease, lentigo maligna melanoma and EMPD.…”

“…The procedure has various terms, such as punch biopsy mapping, multiple scouting biopsies and skin mapping with punch biopsies . Mapping biopsy has been advocated for many tumors that have an unpredictable amount of subclinical spread, such as perianal Bowen's disease, lentigo maligna melanoma and EMPD. Although mapping biopsy has been reported to be beneficial in the treatment of EMPD, the systematic review on the efficacy of MMS in the treatment of EMPD and the superior recurrence rate of MMS compared with wide local resection have been reported .…”

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

“…If tumor dimensions are ill-defined (lentigo maligna, lentigo maligna melanoma, local recurrence), mapping biopsies may aid in determining resection margins [73].…”

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

“…[8][9][10] Some centers have used peripheral sampling techniques for MIS or large melanomas to ensure clear margins before definitive excision, and others have used the Mohs technique. 9,11,12 Even with peripheral sampling, many surgeons will still delay reconstruction (meaning 3 surgeries) until final pathology review of the primary specimen because finding a melanoma within an MIS (up to 12%) or a deeper melanoma than originally biopsied may require wider excision or nodal biopsies. 6,10 Although more widely accepted, the delayed reconstruction approach incurs significant morbidity in patients, and some centers utilize immediate reconstruction in selected cases.…”