Junqian Zhang1, Christopher J Miller2, Joseph F Sobanko2, Thuzar M Shin2, Jeremy R Etzkorn3. 1. Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 2. Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania. 3. Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania. Electronic address: jeremy.etzkorn@uphs.upenn.edu.
Abstract
BACKGROUND: No evidence-based surgical guidelines exist for atypical intraepidermal melanocytic proliferation (AIMP), a descriptive histopathologic diagnosis with uncertain malignant potential. OBJECTIVE: We sought to identify the frequency of and risk factors associated with positive or equivocal margins after conventional excision. METHODS: We conducted a retrospective cross-sectional study of 413 AIMPs treated by conventional excision. RESULTS: Positive or equivocal margins were seen in 2.9% (12/413) of conventional excisions of AIMP. Risk factors associated with positive or equivocal margins included anatomic location on the head and neck (5/51, 9.8%; odds ratio 6.91, 95% confidence interval 1.93-24.80) (P = .012) and a preoperative biopsy specimen that included melanoma in situ in the differential diagnosis (11/214, 5.1%; odds ratio 10.73, 95% confidence interval 1.37-83.88) (P = .006). The frequency of positive or equivocal margins did not differ significantly with surgical margins greater than or less than 5 mm (odds ratio 0.61, 95% confidence interval 0.18-2.07) (P = .457). LIMITATIONS: This was a single-site, retrospective observational study. CONCLUSION: AIMP has a significantly increased risk for incomplete excision when it is located on the head and neck or has a preoperative histologic differential diagnosis that includes melanoma in situ. These subsets of AIMP may benefit from Mohs micrographic surgery or staged surgical excision to confirm clear margins before reconstruction.
BACKGROUND: No evidence-based surgical guidelines exist for atypical intraepidermal melanocytic proliferation (AIMP), a descriptive histopathologic diagnosis with uncertain malignant potential. OBJECTIVE: We sought to identify the frequency of and risk factors associated with positive or equivocal margins after conventional excision. METHODS: We conducted a retrospective cross-sectional study of 413 AIMPs treated by conventional excision. RESULTS: Positive or equivocal margins were seen in 2.9% (12/413) of conventional excisions of AIMP. Risk factors associated with positive or equivocal margins included anatomic location on the head and neck (5/51, 9.8%; odds ratio 6.91, 95% confidence interval 1.93-24.80) (P = .012) and a preoperative biopsy specimen that included melanoma in situ in the differential diagnosis (11/214, 5.1%; odds ratio 10.73, 95% confidence interval 1.37-83.88) (P = .006). The frequency of positive or equivocal margins did not differ significantly with surgical margins greater than or less than 5 mm (odds ratio 0.61, 95% confidence interval 0.18-2.07) (P = .457). LIMITATIONS: This was a single-site, retrospective observational study. CONCLUSION: AIMP has a significantly increased risk for incomplete excision when it is located on the head and neck or has a preoperative histologic differential diagnosis that includes melanoma in situ. These subsets of AIMP may benefit from Mohs micrographic surgery or staged surgical excision to confirm clear margins before reconstruction.
Authors: Nina R Blank; Brian P Hibler; Ian W Tattersall; Courtney J Ensslin; Erica H Lee; Stephen W Dusza; Kishwer S Nehal; Klaus J Busam; Anthony M Rossi Journal: J Am Acad Dermatol Date: 2019-01-14 Impact factor: 11.527
Authors: Sofia Berglund; Eva Johansson Backman; Zahra Baldawi; Linda Horn; Rebecca Arbin Borsiin; Michelle Marjanovic; Thea Christoffersson; Martin Gillstedt; John Paoli Journal: Acta Derm Venereol Date: 2021-03-23 Impact factor: 3.875