Staged melanoma excision requires larger margins for tumor clearance and results in low rates of recurrence

Himeles, Jaclyn Rosenthal; Criscito, Maressa C.; Lee, Nayoung; Stevenson, Mary L.; Carucci, John A.

doi:10.1007/s00403-022-02426-z

Cited by 1 publication

(3 citation statements)

References 24 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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,…”

Section: Study Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

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

O'Hern,

Crum,

Demer

et al. 2024

Dermatol Surg

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BACKGROUND Mohs micrographic surgery (MMS) is increasingly used to treat cutaneous melanoma. However, it is unclear whether intraoperative immunohistochemistry (IHC) improves surgical outcomes. OBJECTIVE To determine whether intraoperative IHC during MMS and staged excision is associated with a decreased risk of poor surgical outcomes. MATERIALS AND METHODS Search of 6 databases identified comparative and noncomparative studies that reported local recurrence after MMS or staged excision with or without IHC for melanoma. Random-effects meta-analysis was used to estimate pooled local recurrence rates, nodal recurrence, distant recurrence, and disease-specific mortality. RESULTS Overall, 57 studies representing 12,043 patients with cutaneous melanoma and 12,590 tumors met inclusion criteria. Combined MMS and staged excision with IHC was associated with decreased local recurrence in patients with invasive melanoma (0.3%, 95% CI: 0–0.6) versus hematoxylin and eosin alone (1.8%, 95% CI: 0.8%–2.8%) [p < .001]. Secondary outcomes including nodal recurrence, distant recurrence, and disease-specific mortality were not significantly different between these 2 groups. Study heterogeneity was moderately-high. CONCLUSION Local recurrence of invasive melanoma is significantly lower after MMS and staged excision with IHC as opposed to without IHC. These findings suggest that the use of intraoperative IHC during MMS or staged excision should strongly be considered, particularly for invasive melanoma. Trial Registration PROSPERO Identifier: CRD42023435630.

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Section: Resultsmentioning

confidence: 99%