Staged margin‐controlled excision (SMEX) for lentigo maligna melanoma in situ

Beveridge, Julie; Taher, Muba; Zhu, Julie; Mahmood, Muhammad Nateque; Salopek, Thomas G.

doi:10.1002/jso.25109

Cited by 9 publications

(10 citation statements)

References 39 publications

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“…36,39,47,48,[56][57][58][59][60][61] The weighted mean ± SD (range) surgical margin necessary for negative histological margins was 7.7 ± 2.0 mm (6.6-13.2) (n = 568). 42,43,46,47,49,56,61,62 Lentigo maligna melanoma. A 10 mm surgical margin resulted in negative histological margins in 78% (40/51) following WLE or SE with partial margin assessment.…”

Section: Surgical Marginsmentioning

confidence: 99%

“…In the subgroup analysis, the weighted mean ± SD (range) stages needed for histological clearance in patients treated by SE was 1.7 ± 0.1 (1.4-2.1) (n = 728), 40,42,44,46,49,56,62,65,66 compared with 1.1 ± 0.03 (1.1-1.2) when HH-RCM (n = 103) was used prior to SE 58,67 (p < 0.0001). Negative histological margins were obtained after the first stage in 86% (89/103) using HH-RCM prior to SE, 58,67 compared with 50% (217/433) without HH-RCM 47,53,57,61,66,68 (p < 0.0001).…”

Section: Surgical Stagesmentioning

confidence: 99%

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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

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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.

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Section: Surgical Marginsmentioning

confidence: 99%

Section: Surgical Stagesmentioning

confidence: 99%

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

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“…Larger lesion diameter was directly correlated with the clinical margin width needed for histologic clearance. In their own variant of this technique, a group from Alberta, Canada reported on their experience using staged margin-controlled excision (SMEX) for the treatment of LM in 24 patients, predominantly located on the face and anterior leg [ 40 ]. They found that a mean of 9 mm clinical margins was required for histologic clearance, in line with prior data.…”

Section: Resultsmentioning

confidence: 99%

Melanoma In Situ: A Critical Review and Re-Evaluation of Current Excision Margin Recommendations

et al. 2021

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Most international clinical guidelines recommend 5-10 mm clinical margins for excision of melanoma in situ (MIS). While the evidence supporting this is weak, these guidelines are generally consistent. However, as a result of the high incidence of subclinical extension of MIS, especially of the lentigo maligna (LM) subtype, wider margins will often be needed to achieve complete histologic clearance. In this review, we assessed all available contemporary evidence on clearance margins for MIS. No randomized trials were identified and the 31 non-randomized studies were largely retrospective reviews of single-surgeon or single-institution experiences using Mohs micrographic surgery (MMS) for LM

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“…However, given that the study did not differentiate between different tumor sites, its findings are subject to controversial debate, even in the US where Mohs surgery is commonly used [5]. Other studies used paraffin-embedded tissue and/or involved wide local excision or staged procedures [2,3,6].…”

Section: Statement Of the German Society Ofmentioning

confidence: 99%

Statement of the German Society of Dermatosurgery: surgical margins in the treatment of melanoma in situ

Bechara

Gauglitz

Kunte

et al. 2019

J Deutsche Derma Gesell

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Staged margin‐controlled excision (SMEX) for lentigo maligna melanoma in situ

Abstract: SMEX offers a reliable surgical excision method that ensures complete excision of LM in a cosmetically sensitive manner. The recurrence outcomes of SMEX are comparable, if not better, than those of alternative excision techniques in the literature.

Cited by 9 publications

References 39 publications

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

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

Melanoma In Situ: A Critical Review and Re-Evaluation of Current Excision Margin Recommendations

Statement of the German Society of Dermatosurgery: surgical margins in the treatment of melanoma in situ

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