The importance of surgical margins in melanoma

Ethun, Cecilia G.; Delman, Keith A.

doi:10.1002/jso.24111

Cited by 40 publications

(31 citation statements)

References 90 publications

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“…For large melanoma, in situ surgical margins >0.5 cm may be necessary to achieve histologically negative margins. A 0.5-cm margin for lentigo maligna melanoma in situ on the head and neck often results in an incomplete excision (4). This is often managed as a staged procedure, where histological clearance is confirmed prior to definitive reconstruction.…”

Section: Review Of Current Guidelines For Excisionmentioning

confidence: 99%

Surgical Management of Melanoma

Joyce

2017

Cutaneous Melanoma: Etiology and Therapy

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This chapter discusses the surgical principles in the management of melanoma. Surgery remains the mainstay of treatment of primary melanoma, and in the majority of cases it is curative. Appropriate surgical management is critical for the diagnosis, staging, and optimal treatment of both in situ and invasive primary cutaneous melanoma. Surgical management is dependent on the stage of the disease, and therefore this chapter evaluates localized, regional, and metastatic disease. The concept of sentinel lymph node biopsy is discussed along with its benefits, pitfalls, and prognostic significance. Furthermore, several important surgical issues are discussed, including the extent of surgical margins, Mohs micrographic surgery for melanoma in situ, and the role of metastasectomy.

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Section: Review Of Current Guidelines For Excisionmentioning

confidence: 99%

Surgical Management of Melanoma

Joyce

2017

Cutaneous Melanoma: Etiology and Therapy

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“…Guidelines for the treatment of melanoma now specifically acknowledge differences in treatment based on anatomic location. 5,6 There is a paucity of evidence to guide decision-making for conventional excision of AIMP; expert dermatopathologists were unable to reach consensus regarding recommended margins for AIMP. 2 The lack of clinical evidence to guide decision-making in the surgical management of AIMP presents a dilemma for treating clinicians, and objective data are necessary to help fill this knowledge gap.…”

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confidence: 99%

Frequency of and factors associated with positive or equivocal margins in conventional excision of atypical intraepidermal melanocytic proliferations (AIMP): A single academic institution cross-sectional study

Zhang

Miller

Sobanko

et al. 2016

Journal of the American Academy of Dermatology

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“…While margins as wide as 5 cm were once commonplace, current guidelines from the National Comprehensive Cancer Network (NCCN), the European Society for Medical Oncology (ESMO), the Swiss Cancer League, and the Australian Cancer Network all recommend margins no greater than 2 cm. 5 Shifting to narrower excision margins represents a potential challenge to physicians who have experienced good oncological outcomes with wider margins. This inertia of prior experience may explain why nearly half of the excisions performed in this study had wider margins than recommended, and why Varey et al 2 found physicians aged 55-64 years were 32% less likely to adhere to guidelines compared with those aged under 45 years.…”

Section: Physician Behaviormentioning

confidence: 99%

Melanoma Surgery: Why Don’t We Let the Guidelines Guide Practice?

Kang

Wong

2017

Ann Surg Oncol

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In the current era of evidence-based medicine, clinical practice guidelines (CPGs), care pathways, and best practice protocols are ubiquitous. CPGs are systematically developed statements, designed to assist clinicians and patients with decisions regarding appropriate care.1 Public health agencies and professional societies tasked with creating these guidelines are faced with the challenge of providing comprehensive, specific, understandable, and clinically usable recommendations. Underlying the tremendous effort of creating CPGs is the assumption that once the guideline is in place, it will be used to guide care.In this issue of Annals of Surgical Oncology, Varey and colleagues present a large, population-based, cross-sectional study evaluating adherence to the Australian Melanoma Management Guidelines.2 The authors note only 35% of wide local excisions (WLEs) were performed with margins concordant with the guidelines; 45% of WLEs had more aggressive margins than recommended and the remainder were excised with inadequate margins. While nearly two-thirds of patients received guidelinediscordant care, implications on rates of recurrence and disease-related morbidity/mortality were not examined in this study and are unknown. To place these findings in a larger context, we must understand why the guidelines are not being followed. Physician knowledge, behavior, and attitudes, as well as a guideline's underlying 'trustworthiness' have all been identified as barriers to the uptake of CPG recommendations. PHYSICIAN KNOWLEDGEIt stands to reason that 'expert' physicians would be more familiar with the guidelines, and the data presented on physician volume support this assertion. Surgeons with high annual melanoma caseloads ([30) were 27% more likely to perform a WLE concordant with the guideline than those with a lower caseload (1-5 cases annually).

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The importance of surgical margins in melanoma

Cited by 40 publications

References 90 publications

Surgical Management of Melanoma

Surgical Management of Melanoma

Frequency of and factors associated with positive or equivocal margins in conventional excision of atypical intraepidermal melanocytic proliferations (AIMP): A single academic institution cross-sectional study

Melanoma Surgery: Why Don’t We Let the Guidelines Guide Practice?

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