Melanoma Margins: The Importance and Need for More Evidence-Based Trials

Johnson, Timothy M.; Sondak, Vernon K.

doi:10.1001/archderm.140.9.1148

Cited by 13 publications

(6 citation statements)

References 9 publications

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“…In response to this criticism, discussions are ongoing to initiate an international collaboration to carry out a prospective, randomized margin of excision trial of 1 cm versus 2 cm in the management of melanomas > 2 mm in thickness that would be powered to demonstrate that the narrow margin is equivalent to the wider margin. Concerns over trends in survival in favor of wider excision that do not reach statistical significance because of lack of statistical power in trial design as observed in the Intergroup and UKMSG studies is partially addressed in the aforementioned meta‐analysis, but would be more fully addressed by this next important clinical trial 39.…”

Section: Wide Excision Of the Primary Melanomamentioning

confidence: 99%

Evidence‐based treatment of early‐stage melanoma

Ross

Gershenwald

2011

Journal of Surgical Oncology

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The vast majority of patients with newly diagnosed melanoma are "early-stage" - ie, clinically localized to the primary cutaneous site. For such patients, surgery represents the mainstay of treatment; current standards of surgical management have evolved based on evidence obtained from randomized trials, large multi-center and single institutional databases, and consensus panels. Treatment strategies include wide excision of the primary site with margins dictated by important biological features such as Breslow tumor thickness, and sentinel node biopsy to surgically evaluate the regional nodal basins at risk. Sentinel node biopsy has become an important component of the initial management of many of these patients for accurate staging of regional lymph nodes, as well as enhanced regional disease control and improved survival in the patients with microscopically involved nodes. Evidence is presented that supports the rational use of these surgical strategies and reconciles some of the controversies that have emerged. The degree to which established national treatment guidelines are followed and the consequences of non-compliance with these guidelines have become the focus of recent clinical investigations; results of these efforts are also discussed.

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Section: Wide Excision Of the Primary Melanomamentioning

confidence: 99%

Evidence‐based treatment of early‐stage melanoma

Ross

Gershenwald

2011

Journal of Surgical Oncology

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“…While these recommendations have provided a more rational approach to resection margins in melanoma, controversy remains regarding margins for some melanomas [21]. Recently, a multicenter, randomized trial involving 900 patients, with a mean follow-up of 60 months, compared 1-and 3-cm margins for melanoma 2 mm or thicker [22].…”

Section: Melanoma Marginsmentioning

confidence: 99%

“…This 5-year follow-up study of 535 patients with 553 primary melanomas investigated MMS using fresh tissue with frozen-section examination of the tumor margin. The 5-year local recurrence rate was 0.5% for both MIS and Adapted from [5,21].…”

Section: Fresh-tissue Technique To Treat Melanomamentioning

confidence: 99%

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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“…(c) There is currently no standard approach for measuring the cutaneous margin of excision or for pathologic assessment of the margin, especially for melanomas thicker than 2 mm. Markers allowing to establish optimal excision margins would reduce risk of recurrence, especially in patients with deeper tumors (10). (d) Some melanomas lack typical diagnostic criteria and are difficult to recognize in the early stages.…”

Section: Challenges In Clinical Management Of Melanomamentioning

confidence: 99%

Markers and Tissue Resources for Melanoma: Meeting Report

Becker

Mihm²,

Hewitt³

et al. 2006

Cancer Research

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The Markers and Tissue Resources for Melanoma meeting convened by the Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, Specialized Programs of Research Excellence at the Organ Systems Branch of the National Cancer Institute (NCI), and the Melanoma Research Foundation was held in Gaithersburg, MD on October 2005. The meeting reviewed the current status of biomarkers for early- and advanced-stage melanoma and addressed some of the challenges scientists and clinicians face as they unravel the biology of melanoma and try to apply these findings to patient care. Specifically, the participants focused on molecular changes associated with melanoma progression, potential diagnostic and prognostic markers emerging from molecular profiling studies, and new treatment targets for current and future clinical trials. They also highlighted the ongoing challenges about translational research in melanoma, including availability of tissue resources, and summarized the status of nevus and melanoma tissue microarrays, recently developed as a collaborative project between the melanoma research community and the NCI. The meeting report is intended to provide a perspective on emerging scientific approaches in translational research that can enhance the progress in discovery and validation of markers for melanoma. (Cancer Res 2006; 66(22): 10652-7)

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Melanoma Margins: The Importance and Need for More Evidence-Based Trials

Cited by 13 publications

References 9 publications

Evidence‐based treatment of early‐stage melanoma

Evidence‐based treatment of early‐stage melanoma

Mohs surgery and margin control in the treatment of melanoma

Markers and Tissue Resources for Melanoma: Meeting Report

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