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Histological Peripheral Margins and Recurrence of Melanoma In Situ Treated with Wide Local Excision
BACKGROUND: The incidence of melanoma in situ (MIS) is increasing faster compared to invasive melanoma. Despite varying international practice, a minimum of 5 mm surgical excision margin is currently recommended in the UK. There is no clear guidance on the minimum histological peripheral clearance m...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644340/ https://www.ncbi.nlm.nih.gov/pubmed/33178463 http://dx.doi.org/10.1155/2020/8813050 |
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author | Moura, Francisco S. Homer, Lucy E. McKirdy, Stuart W. |
author_facet | Moura, Francisco S. Homer, Lucy E. McKirdy, Stuart W. |
author_sort | Moura, Francisco S. |
collection | PubMed |
description | BACKGROUND: The incidence of melanoma in situ (MIS) is increasing faster compared to invasive melanoma. Despite varying international practice, a minimum of 5 mm surgical excision margin is currently recommended in the UK. There is no clear guidance on the minimum histological peripheral clearance margins. AIM: This study compares the histological peripheral clearance margins of MIS using wide local excision (WLE) to the rate of recurrence and progression to invasive disease. METHODS: A retrospective single-center review was performed over a 5-year period. Inclusion criteria consisted of MIS diagnosis, ≥16 years of age, and treatment with WLE with curative intent. Those patients with a recurrence of a previous MIS or with a reported focus of invasion/regression were also included. Clinicopathological data and follow-up were recorded. RESULTS: 167 MIS were identified in 155 patients, 80% of which were lentigo maligna subtype. Of patients with completely excised MIS on histology (>0 mm), 9% had recurrence with a median time to recurrence of 36 months. Three (1.8%) cases recurred as invasive disease. Age, MIS site, MIS subtype, and histological evidence of foci of invasion/regression did not predict recurrence nor progression to invasive disease (p > 0.05). The recurrence rate of MIS with a histological excision margin ≤3.0 mm was 13% compared to 3% in those with histology margins of >3.0 mm (p=0.049). CONCLUSION: A histological peripheral clearance of at least 3.0 mm is advocated to achieve lower recurrence rates. The follow-up duration should be reviewed due to the median recurrence occurring at 36 months in our cohort. Cumulative work on MIS needs to be collated and completed in a large multicenter study with a long follow-up period. |
format | Online Article Text |
id | pubmed-7644340 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-76443402020-11-10 Histological Peripheral Margins and Recurrence of Melanoma In Situ Treated with Wide Local Excision Moura, Francisco S. Homer, Lucy E. McKirdy, Stuart W. J Skin Cancer Research Article BACKGROUND: The incidence of melanoma in situ (MIS) is increasing faster compared to invasive melanoma. Despite varying international practice, a minimum of 5 mm surgical excision margin is currently recommended in the UK. There is no clear guidance on the minimum histological peripheral clearance margins. AIM: This study compares the histological peripheral clearance margins of MIS using wide local excision (WLE) to the rate of recurrence and progression to invasive disease. METHODS: A retrospective single-center review was performed over a 5-year period. Inclusion criteria consisted of MIS diagnosis, ≥16 years of age, and treatment with WLE with curative intent. Those patients with a recurrence of a previous MIS or with a reported focus of invasion/regression were also included. Clinicopathological data and follow-up were recorded. RESULTS: 167 MIS were identified in 155 patients, 80% of which were lentigo maligna subtype. Of patients with completely excised MIS on histology (>0 mm), 9% had recurrence with a median time to recurrence of 36 months. Three (1.8%) cases recurred as invasive disease. Age, MIS site, MIS subtype, and histological evidence of foci of invasion/regression did not predict recurrence nor progression to invasive disease (p > 0.05). The recurrence rate of MIS with a histological excision margin ≤3.0 mm was 13% compared to 3% in those with histology margins of >3.0 mm (p=0.049). CONCLUSION: A histological peripheral clearance of at least 3.0 mm is advocated to achieve lower recurrence rates. The follow-up duration should be reviewed due to the median recurrence occurring at 36 months in our cohort. Cumulative work on MIS needs to be collated and completed in a large multicenter study with a long follow-up period. Hindawi 2020-10-29 /pmc/articles/PMC7644340/ /pubmed/33178463 http://dx.doi.org/10.1155/2020/8813050 Text en Copyright © 2020 Francisco S. Moura et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Moura, Francisco S. Homer, Lucy E. McKirdy, Stuart W. Histological Peripheral Margins and Recurrence of Melanoma In Situ Treated with Wide Local Excision |
title | Histological Peripheral Margins and Recurrence of Melanoma In Situ Treated with Wide Local Excision |
title_full | Histological Peripheral Margins and Recurrence of Melanoma In Situ Treated with Wide Local Excision |
title_fullStr | Histological Peripheral Margins and Recurrence of Melanoma In Situ Treated with Wide Local Excision |
title_full_unstemmed | Histological Peripheral Margins and Recurrence of Melanoma In Situ Treated with Wide Local Excision |
title_short | Histological Peripheral Margins and Recurrence of Melanoma In Situ Treated with Wide Local Excision |
title_sort | histological peripheral margins and recurrence of melanoma in situ treated with wide local excision |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644340/ https://www.ncbi.nlm.nih.gov/pubmed/33178463 http://dx.doi.org/10.1155/2020/8813050 |
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