BACKGROUND: A controversy in the treatment of melanoma in situ is the required width of surgical margin. The currently accepted 5-mm margin is based on a 1992 consensus opinion, despite data since then showing this is inadequate. OBJECTIVE: We sought to develop guidelines for predetermined surgical margins for excision of melanoma in situ. METHODS: A prospectively collected series of 1072 patients with 1120 melanoma in situs was studied. All lesions were excised by Mohs micrographic surgery with frozen-section examination of the margin. The minimal surgical margin was 6 mm, and the total margin was calculated by adding an additional 3 mm for each subsequent stage required. The minimum surgical margin that would successfully remove 97% of all tumors was calculated. Local recurrence was also tabulated. RESULTS: In all, 86% of melanoma in situs were successfully excised with a 6-mm margin; 9 mm removed 98.9% of melanoma in situs. The superiority of 9-mm to 6-mm margins was significant (P < .001). Gender, location, and diameter did not affect results. Recurrence rate for this set of patients treated with Mohs micrographic surgery was 0.3% (n = 3). LIMITATIONS: Margins less than 6 mm were not studied. This is a referral center for melanoma in situ and 10% of tumors were previously treated before presentation to our clinic. CONCLUSION: The frequently recommended 5-mm margin for melanoma is inadequate. Standard surgical excision of melanoma in situ should include 9 mm of normal-appearing skin, similar to that recommended for early invasive melanoma.
BACKGROUND: A controversy in the treatment of melanoma in situ is the required width of surgical margin. The currently accepted 5-mm margin is based on a 1992 consensus opinion, despite data since then showing this is inadequate. OBJECTIVE: We sought to develop guidelines for predetermined surgical margins for excision of melanoma in situ. METHODS: A prospectively collected series of 1072 patients with 1120 melanoma in situs was studied. All lesions were excised by Mohs micrographic surgery with frozen-section examination of the margin. The minimal surgical margin was 6 mm, and the total margin was calculated by adding an additional 3 mm for each subsequent stage required. The minimum surgical margin that would successfully remove 97% of all tumors was calculated. Local recurrence was also tabulated. RESULTS: In all, 86% of melanoma in situs were successfully excised with a 6-mm margin; 9 mm removed 98.9% of melanoma in situs. The superiority of 9-mm to 6-mm margins was significant (P < .001). Gender, location, and diameter did not affect results. Recurrence rate for this set of patients treated with Mohs micrographic surgery was 0.3% (n = 3). LIMITATIONS: Margins less than 6 mm were not studied. This is a referral center for melanoma in situ and 10% of tumors were previously treated before presentation to our clinic. CONCLUSION: The frequently recommended 5-mm margin for melanoma is inadequate. Standard surgical excision of melanoma in situ should include 9 mm of normal-appearing skin, similar to that recommended for early invasive melanoma.
Authors: Evan S Glazer; Caitlin F Porubsky; Jeffrey D Francis; Jamie Ibanez; Nicholas Castner; Jane L Messina; Amod A Sarnaik; Michael A Harrington; C Wayne Cruse; Vernon K Sondak; Jonathan S Zager Journal: Ann Plast Surg Date: 2017-06 Impact factor: 1.539
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Authors: Luiz Guilherme Martins Castro; Maria Cristina Messina; Walter Loureiro; Ricardo Silvestre Macarenco; João Pedreira Duprat Neto; Thais Helena Bello Di Giacomo; Flávia Vasques Bittencourt; Renato Marchiori Bakos; Sérgio Schrader Serpa; Hamilton Ometto Stolf; Gabriel Gontijo Journal: An Bras Dermatol Date: 2015 Nov-Dec Impact factor: 1.896
Authors: Jeremy R Etzkorn; Joseph F Sobanko; Thuzar M Shin; Rosalie Elenitsas; Emily Y Chu; Joel M Gelfand; David J Margolis; Jason G Newman; Hayley Goldbach; Christopher J Miller Journal: Dermatol Surg Date: 2016-04 Impact factor: 3.398