Planning slow Mohs excision margins for lentigo maligna: a retrospective nonrandomized cohort study comparing reflectance confocal microscopy margin mapping vs. visual inspection with dermoscopy

Gao, Junheng; Garioch, J.; Fadhil, May; Tan, E.; Shah, Nimish; Moncrieff, Marc

doi:10.1111/bjd.19764

Cited by 4 publications

(6 citation statements)

References 6 publications

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“…This might indicate a beneficial effect of presurgical mapping by HH‐RCM combined with any surgical technique. Nonetheless, these data should be considered with some caution, as one single comparative study by Gao et al, 35 could not demonstrate a significant reduction in necessary surgical stages. Even so, HH‐RCM did allow for better presurgical planning with a significant reduction in time to closure, and significant results might be achieved by larger adequate comparative studies and increased experience of the HH‐RCM user.…”

Section: Discussionmentioning

confidence: 93%

“…Negative histological margins were obtained after the first stage in 86% (89/103) using HH‐RCM prior to SE, 58,67 compared with 50% (217/433) without HH‐RCM 47,53,57,61,66,68 ( p < 0.0001). For MMS‐treated patients ( n = 894) the weighted mean ± SD (range) stages for histological clearance was 1.6 ± 0.3 (1.4–2.3), 34,35,37,40,43,69–71 compared to 1.3 with HH‐RCM mapping prior to MMS ( n = 21) 35 ( p < 0.001). Negative histological margins were obtained after the first stage in 81% (17/21) using HH‐RCM prior to MMS, 35 compared with 77% (1333/1723) without HH‐RCM 35,36,43,59,70,72 ( p = 0.69).…”

Section: Resultsmentioning

confidence: 99%

“…For MMS‐treated patients ( n = 894) the weighted mean ± SD (range) stages for histological clearance was 1.6 ± 0.3 (1.4–2.3), 34,35,37,40,43,69–71 compared to 1.3 with HH‐RCM mapping prior to MMS ( n = 21) 35 ( p < 0.001). Negative histological margins were obtained after the first stage in 81% (17/21) using HH‐RCM prior to MMS, 35 compared with 77% (1333/1723) without HH‐RCM 35,36,43,59,70,72 ( p = 0.69).…”

Section: Resultsmentioning

confidence: 99%

“…A single comparative study directly compared HH‐RCM‐assisted MMS to classic MMS, with clearance rates of 81% (17/21) and 62% (16/26) after the first stage, respectively 35 . Even though this difference was not significant, HH‐RCM did significantly reduce the time to closure (14 vs. 27 days; p = 0.038).…”

Section: Resultsmentioning

confidence: 99%

“…A clinical data summary of the 41 included studies is shown in Table 1 (full details available in Appendix S3). Seven of the included studies were comparative cohort studies, [34][35][36][37][38][39][40] while the 34 remaining studies consisted of single-arm cohort studies. No randomized controlled trials were identified.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Lentigo maligna (melanoma): A systematic review and meta‐analysis on surgical techniques and presurgical mapping by reflectance confocal microscopy

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Tio

With

et al. 2023

Acad Dermatol Venereol

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Because of an increased risk of local recurrence following surgical treatment of lentigo maligna (melanoma) (LM/LMM), the optimal surgical technique is still a matter of debate. We aimed to evaluate the effect of different surgical techniques and reflectance confocal microscopy (RCM) on local recurrence and survival outcomes. We searched MEDLINE, Embase and PubMed databases through 20 May 2022. Randomized and observational studies with ≥10 lesions were eligible for inclusion. Bias assessment was performed using the Methodological Index for Non‐Randomized Studies instrument. Meta‐analysis was performed for local recurrence, as there were insufficient events for the other clinical outcomes. We included 41 studies with 5059 LM and 1271 LMM. Surgical techniques included wide local excision (WLE) (n = 1355), staged excision (n = 2442) and Mohs' micrographic surgery (MMS) (n = 2909). Six studies included RCM. The guideline‐recommended margin was insufficient in 21.6%–44.6% of LM/LMM. Local recurrence rate was lowest for patients treated by MMS combined with immunohistochemistry (<1%; 95% CI, 0.3%–1.9%), and highest for WLE (13%; 95% CI, 7.2%–21.6%). The mean follow‐up varied from 27 to 63 months depending on surgical technique with moderate to high heterogeneity for MMS and WLE. Handheld‐RCM decreased both the rate of positive histological margins (p < 0.0001) and necessary surgical stages (p < 0.0001). The majority of regional (17/25) and distant (34/43) recurrences occurred in patients treated by WLE. Melanoma‐associated mortality was low (1.5%; 32/2107), and more patients died due to unrelated causes (6.7%; 107/1608). This systematic review shows a clear reduction in local recurrences using microscopically controlled surgical techniques over WLE. The use of HH‐RCM showed a trend in the reduction in incomplete resections and local recurrences even when used with WLE. Due to selection bias, heterogeneity, low prevalence of stage III/IV disease and limited survival data, it was not possible to determine the effect of the different surgical techniques on survival outcomes.

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Section: Discussionmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 3 more Smart Citations

Lentigo maligna (melanoma): A systematic review and meta‐analysis on surgical techniques and presurgical mapping by reflectance confocal microscopy

Elshot

Tio

With

et al. 2023

Acad Dermatol Venereol

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Enhanced disease-specific survival in lentigo maligna melanoma patients treated with Mohs surgery over wide local excision: A retrospective cohort analysis of the Surveillance, Epidemiology, and End Results database

Taylor,

Thomas,

Fernandez

et al. 2024

Journal of the American Academy of Dermatology

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Surgical margin mapping for lentigo maligna and lentigo maligna melanoma: traditional technique (visual inspection with dermoscopy) versus combined paper tape and reflectance confocal microscopy technique

et al. 2023

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Background The detection of subclinical margin in lentigo maligna/lentigo maligna melanoma (LM/LMM) can be challenging for the dermatologist. Reflectance confocal microscopy (RCM) enables to observe in vivo atypical melanocytes beyond the clinical margins. The aim of this study is to establish which of these methods (clinical examination and dermoscopy versus “Paper tape – RCM”) is more precise to define the lesion margin and to reduce the number of re‐intervention and overtreatments in cosmetically sensitive areas. Methods Fifty‐seven cases of LM/LMM were analyzed during 2016–2022. Pre‐surgical mapping procedures in 32 lesions were effectuated with dermatoscopy. Furthermore, pre‐surgical mapping procedures in 25 lesions were effectuated with RCM and paper tape. Results RCM method's accuracy to detect subclinical margins was 92.0%. In 24 of 25 cases, the lesions were excised completely during the first intervention. In 20 of 32 cases analyzed with dermoscopy, a second surgical intervention was effectuated. Conclusion The RCM paper method allows us to delineate subclinical margin more accurately and reduce overtreatment, especially in sensitive areas, such as the face and neck.

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Planning slow Mohs excision margins for lentigo maligna: a retrospective nonrandomized cohort study comparing reflectance confocal microscopy margin mapping vs. visual inspection with dermoscopy

Cited by 4 publications

References 6 publications

Lentigo maligna (melanoma): A systematic review and meta‐analysis on surgical techniques and presurgical mapping by reflectance confocal microscopy

Lentigo maligna (melanoma): A systematic review and meta‐analysis on surgical techniques and presurgical mapping by reflectance confocal microscopy

Enhanced disease-specific survival in lentigo maligna melanoma patients treated with Mohs surgery over wide local excision: A retrospective cohort analysis of the Surveillance, Epidemiology, and End Results database

Surgical margin mapping for lentigo maligna and lentigo maligna melanoma: traditional technique (visual inspection with dermoscopy) versus combined paper tape and reflectance confocal microscopy technique

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