Treatment of Head and Neck Melanoma In Situ With Staged Contoured Marginal Excisions

Abstract

Staged marginal evaluation of melanoma in situ (MIS) is performed in order to avoid reconstruction on positive margins. Contoured marginal excision (CME) is an excision of a 2mm wide strip of normal-appearing skin taken 5mm from the visible tumor periphery. If positive, a new CME is excised; the tumor is resected once negative margins are confirmed. The purpose of this study is to report our experience using this technique for the treatment of head/neck MIS. Clinicopathological data were abstracted for all patients who underwent staged CME followed by central tumor resection for head/neck MIS; patients with invasive melanoma were excluded. Statistical analyses included χ2 and t-test. Overall, 127 patients with MIS were identified. 56% were male; the average age was 68 years. The median number of CME procedures per patient was 1 (range 1 to 4). 23% of patients required more than one CME procedure to achieve negative margins. Local recurrence occurred in 3/127 patients after a median follow-up of 5 months. Patients requiring multiple CME procedures were more likely to experience local recurrence (P<0.001). In conclusion, this technique is an effective method to avoid reconstruction on positive MIS margins with high local disease control rates.

Lentigo Maligna of the head and neck: A retrospective study assessing surgical excision margins in a South African population

“…SE offers a superior alternative to conventional WLE with complete peripheral margin evaluation resulting in lower recurrence rates. 3 , 11 , 12 , 13 , 14 …”

“…Previous studies confirmed that SE with rushed permanent sections is superior in obtaining clearance and reduced recurrence rates when compared to conventional WLE since it allows for complete control of the peripheral excision margins. 3 , 11 , 12 , 13 , 14 Recurrence rates for LM after SE have been reported as 1.8% to 4%. 11 , 12 …”

Evolution of Excisional Surgery Practices for Melanoma in the United States

“…6 Concerns about outcomes for melanomas in cosmetic or functionally important locations have led several surgical groups to selectively use alternative surgical strategies with more comprehensive margin assessment before reconstruction. [7][8][9][10][11][12] Comprehensive margin assessment surgery often uses en face tissue processing to visualize a greater percentage of the surgical margins 13 and may be performed with paraffin-embedded permanent sections 10,11 or with frozen sections, 7,9,12 as in Mohs surgery. Mohs surgery was used for 3.5% of all melanomas from 2003 and 2009 according to Surveillance, Epidemiology, and End Results (SEER) data.…”

Association between excision margins and local recurrence in 1407 patients with primary in situ melanomas

“…It is important to note that most guidelines recommend surgical margins but do not specify desirable pathological margins for the management of MIS. While obtaining large margins on the head and neck is often difficult, 20 surgical excision margins [8 mm are now generally advised for LM. 13,14 While it is often possible for experienced practitioners to identify single junctional melanocytes on frozen sections with standard H&E staining or with rapid immunostains during Mohs surgery or CCPDMA, it can be challenging to determine the nature and significance of single melanocytes without interpreting them in the context of the main part of the lesion or the sun damaged background and its associated solar melanocytosis.…”