Melanocytes in Long-standing Sun-Exposed Skin

Hendi, Ali; Brodland, David G.; Zitelli, John A.

doi:10.1001/archderm.142.7.871

Cited by 104 publications

(59 citation statements)

References 21 publications

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“…These authors noted Melan-A-positive nests at the dermal-epidermal junction of a patient with discoid lupus, while S-100 and combined tyrosinase/HMB-45 demonstrated melanocytes distributed in a normal pattern. This finding may also account for the dermal cells noted by Hendi [41], as discussed above.…”

Section: Immunostaining Increases Accuracy Of Surgical Margin Evaluationsupporting

confidence: 53%

“…Hendi and colleagues attempted to distinguish early melanoma from normal sun-damaged skin by quantifying the density, confluence and depth of follicular penetration of melanocytes in the sun-exposed skin of the face and neck [41]. Redundant tissue cones from the repair of 149 Mohs surgical procedures for basal cell carcinoma or squamous cell carcinoma were analyzed by frozen section and stained with Mart-1.…”

Section: Issues Regarding Frozen Sectionsmentioning

confidence: 99%

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Mohs surgery and margin control in the treatment of melanoma

Ritter¹,

Stasko²

2007

Expert Review of Dermatology

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Mohs micrographic surgery (MMS), a surgical and histopathological technique that permits histologic analysis of the entire deep and superficial tumor margin, has been used successfully to treat many types of cutaneous malignancy. MMS results in cure rates as high as 99% for nonmelanoma skin cancer and is particularly useful in areas where standard surgical margins would result in cosmetic and functional deficits. The use of MMS for the treatment of melanoma has been controversial. This controversy stems from the perceived difficulty of diagnosing melanoma in frozen sections and a lack of prospective studies documenting equivalence or superiority to standard wide excision. We review the Mohs technique, detail the challenges facing MMS in the treatment of melanoma and discuss the evidence supporting its use. Despite the challenges, we find evidence of the effectiveness of MMS in the treatment of melanoma, particularly lentigo maligna of the face. 289-298 (2007) Mohs micrographic surgery (MMS) has been shown to be effective in the management of melanoma [1][2][3][4][5][6] beginning with a report by Frederic Mohs in 1950 [7]. Its use, however, has been controversial and there are a number of authors who are opposed to using MMS for the treatment of melanoma [7][8][9][10]. Although some reluctance has stemmed from surgical aspects, such as concerns of spreading melanoma during its surgical removal, lack of prospective studies in the treatment of melanoma or, possibly, interfering with sentinel node biopsy, much of the controversy centers on the difficulty of accurate interpretation of residual melanoma on frozen sections. The development of techniques providing high-quality frozen sections or rush paraffin-embedded permanent sections augmented, when appropriate, by immunostains has alleviated some of these concerns. We will discuss a brief history of the Mohs surgical technique, review current recommended margins for standard excision surgery of melanoma, review the application of MMS in the treatment of melanoma, discuss some of the controversy surrounding its use and develop a perspective of its current use in the treatment of melanoma. Brief history of MMSMohs pioneered a revolutionary method of surgically excising malignant cutaneous neoplasms. His procedure allowed for precise histologic mapping of the tumor margin. In MMS, horizontal sectioning enables observation of the entire undersurface, as well as the peripheral skin edge of the excised specimen, providing visualization of the entire tumor margin. This method is in contrast to the bread-loafing technique used to examine margins in specimens from standard excisional surgery, which allows for histologic examination of less than 1% of the margin. By color coding and mapping the specimen, MMS allows for the precise localization of any positive margins and facilitates further removal of the residual cancer, while preserving uninvolved normal skin. MMS is a maximally tissue-sparing technique, minimizing defect size, while completely removing the tumor. With co...

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Section: Immunostaining Increases Accuracy Of Surgical Margin Evaluationsupporting

confidence: 53%

Section: Issues Regarding Frozen Sectionsmentioning

confidence: 99%

Mohs surgery and margin control in the treatment of melanoma

Ritter¹,

Stasko²

2007

Expert Review of Dermatology

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“…4,42–49 The overall estimate of MD was 955.05 cells/mm 2 (95% CI 880.89–1029.21). The genitalia had the highest MD, followed by the head/neck, upper extremities, lower extremities, and trunk.…”

Section: Resultsmentioning

confidence: 98%

Reference values for skin microanatomy: A systematic review and meta-analysis of ex vivo studies

Fonseca

Wolner

et al. 2017

Journal of the American Academy of Dermatology

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Background Few studies have characterized reference values of normal human skin microanatomy parameters. Objective To quantify histologic measurements of epidermal thickness (ET), melanocyte density (MD), hair follicle density (HFD), and eccrine gland density (EGD), as a function of age and anatomic site. Methods We searched PubMed, Embase, Web of Science and Cochrane databases for articles published through May 25, 2017. Two reviewers independently screened 2,016 articles; 327 relevant articles and 151 additional articles found via forward or reference citations underwent full-text review by one of four reviewers for relevance, data extraction, and critical appraisal. Weighted averages, meta-analysis, and meta-regression were used in statistical analysis. Results Fifty-six articles were included; using all anatomic locations, overall estimates for ET, MD, HFD, and EGD were 99.75 microns (95% CI 83.25–116.25), 955.05 cells/mm2 (95% CI 880.89–1029.21), 1.40 hairs/mm2 (95% CI 0.91–1.89), and 1.28 glands/mm2 (95% CI 0.91–1.64), respectively. Limitations There was significant data heterogeneity across studies, possibly due to differences in histological techniques and absence of standardized microanatomy definitions. Conclusion We established summary estimates for normal human skin microanatomy parameters.

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“…1,2,11,18,20,21 While nesting and pagetoid spread are less commonly found in benign sun-damaged skin, they may occur. 1,2 The findings in our specimens that overlapped with melanoma in situ were focal and isolated and in no instance would the J AM ACAD DERMATOL VOLUME 64, NUMBER 3 pathologist have struggled with the diagnosis. Although our results are reassuring, we concede that criteria remain somewhat subjective and that pathologists should remain cautious in the interpretation of melanocytic margins on sun-damaged skin.…”

Section: Discussionmentioning

confidence: 99%