Cargando…

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

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 lenti...

Descripción completa

Detalles Bibliográficos
Autores principales: Friedman, Erica B., Scolyer, Richard A., Williams, Gabrielle J., Thompson, John F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Healthcare 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8280024/
https://www.ncbi.nlm.nih.gov/pubmed/34047915
http://dx.doi.org/10.1007/s12325-021-01783-x
_version_ 1783722565822316544
author Friedman, Erica B.
Scolyer, Richard A.
Williams, Gabrielle J.
Thompson, John F.
author_facet Friedman, Erica B.
Scolyer, Richard A.
Williams, Gabrielle J.
Thompson, John F.
author_sort Friedman, Erica B.
collection PubMed
description 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 or staged excision (SE) for treatment of MIS on the head/neck and/or LM specifically. The available data challenge the adequacy of current international guidelines as they consistently demonstrate the need for clinical margins > 5 mm and often > 10 mm. For LM, any MIS on the head/neck, and/or ≥ 3 cm in diameter, all may require wider clinical margins because of the higher likelihood of subclinical spread. Histologic clearance should be confirmed prior to undertaking complex reconstruction. However, it is not clear whether wider margins are necessary for all MIS subtypes. Indeed, it seems that this is unlikely to be the case. Until optimal surgical margins can be better defined in a randomized trial setting, ideally controlling for MIS subtype and including correlation with histologic excision margins, techniques such as preliminary border mapping of large, ill-defined lesions and, most importantly, sound clinical judgement will be needed when planning surgical clearance margins for the treatment of MIS.
format Online
Article
Text
id pubmed-8280024
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Springer Healthcare
record_format MEDLINE/PubMed
spelling pubmed-82800242021-07-20 Melanoma In Situ: A Critical Review and Re-Evaluation of Current Excision Margin Recommendations Friedman, Erica B. Scolyer, Richard A. Williams, Gabrielle J. Thompson, John F. Adv Ther Review 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 or staged excision (SE) for treatment of MIS on the head/neck and/or LM specifically. The available data challenge the adequacy of current international guidelines as they consistently demonstrate the need for clinical margins > 5 mm and often > 10 mm. For LM, any MIS on the head/neck, and/or ≥ 3 cm in diameter, all may require wider clinical margins because of the higher likelihood of subclinical spread. Histologic clearance should be confirmed prior to undertaking complex reconstruction. However, it is not clear whether wider margins are necessary for all MIS subtypes. Indeed, it seems that this is unlikely to be the case. Until optimal surgical margins can be better defined in a randomized trial setting, ideally controlling for MIS subtype and including correlation with histologic excision margins, techniques such as preliminary border mapping of large, ill-defined lesions and, most importantly, sound clinical judgement will be needed when planning surgical clearance margins for the treatment of MIS. Springer Healthcare 2021-05-28 2021 /pmc/articles/PMC8280024/ /pubmed/34047915 http://dx.doi.org/10.1007/s12325-021-01783-x Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Review
Friedman, Erica B.
Scolyer, Richard A.
Williams, Gabrielle J.
Thompson, John F.
Melanoma In Situ: A Critical Review and Re-Evaluation of Current Excision Margin Recommendations
title Melanoma In Situ: A Critical Review and Re-Evaluation of Current Excision Margin Recommendations
title_full Melanoma In Situ: A Critical Review and Re-Evaluation of Current Excision Margin Recommendations
title_fullStr Melanoma In Situ: A Critical Review and Re-Evaluation of Current Excision Margin Recommendations
title_full_unstemmed Melanoma In Situ: A Critical Review and Re-Evaluation of Current Excision Margin Recommendations
title_short Melanoma In Situ: A Critical Review and Re-Evaluation of Current Excision Margin Recommendations
title_sort melanoma in situ: a critical review and re-evaluation of current excision margin recommendations
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8280024/
https://www.ncbi.nlm.nih.gov/pubmed/34047915
http://dx.doi.org/10.1007/s12325-021-01783-x
work_keys_str_mv AT friedmanericab melanomainsituacriticalreviewandreevaluationofcurrentexcisionmarginrecommendations
AT scolyerricharda melanomainsituacriticalreviewandreevaluationofcurrentexcisionmarginrecommendations
AT williamsgabriellej melanomainsituacriticalreviewandreevaluationofcurrentexcisionmarginrecommendations
AT thompsonjohnf melanomainsituacriticalreviewandreevaluationofcurrentexcisionmarginrecommendations