Surgical Margins for Lentigo Maligna, 2004

Zitelli, John A.

doi:10.1001/archderm.140.5.607

Cited by 16 publications

(13 citation statements)

References 7 publications

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“…Having said this, the clearance rate of MIS 95.1% achieved by MMS in this series is significantly higher than 83% to 85% clearance rate achieved with the standard surgical excision with 5‐mm margin 6,7 . When stratified by histologic subtype, the clearance rate for MIS LM type of 95.7% and the clearance rate for MIS of non‐LM type of 94.1% are about the same.…”

Section: Discussionmentioning

confidence: 57%

Mohs Micrographic Surgery is Accurate 95.1% of the Time for Melanoma In Situ: A Prospective Study of 167 Cases

2008

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Section: Discussionmentioning

confidence: 57%

Mohs Micrographic Surgery is Accurate 95.1% of the Time for Melanoma In Situ: A Prospective Study of 167 Cases

2008

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“…Based on the current WHO recommendations, there are reported recurrence rates of 3% on the trunk and extremities where wide margins are readily taken for mainly nodular melanomas [23,24]. In these settings (excluding hands, feet and genitalia), taking wide surgical margins in the 1-2-cm range is more easily performed without significant functional or cosmetic concern.…”

Section: Melanoma Marginsmentioning

confidence: 99%

“…In these settings (excluding hands, feet and genitalia), taking wide surgical margins in the 1-2-cm range is more easily performed without significant functional or cosmetic concern. Unfortunately, treatment of head and neck melanoma, including lentigo maligna (LM), has recurrence rates of 8-20% using these standard margins [24][25][26]. This high recurrence rate may be due, in part, to the behavior of LM, a form of MIS, which is often ill-defined clinically and travels in unpredictable directions [17,27].…”

Section: Melanoma Marginsmentioning

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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“…Surgery is the recommended first‐line treatment for LM, with current guidelines proposing excision margins of 5 mm . However, there is evidence to suggest that this may be inadequate because of subclinical melanocyte extension, which can increase the risk of disease recurrence and need for re‐excision . Although larger margins may help to tackle this, they may result in poorer aesthetic and functional outcomes for the patient.…”

mentioning

confidence: 99%

Diagnosis and management of lentigo maligna: an observational study comparing 2005 with 2014 data in one institution

Hawkey

Affleck

2017

Clin Exp Dermatol

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The incidence, clinical characteristics and management of lentigo maligna (LM) were assessed in a university hospital setting in 2005 and 2014. Multiple clinical variables were compared, and 28 and 43 cases, respectively were identified during the two time periods. The most common site of presentation was the cheek (50% vs. 44%), and an accurate clinical diagnosis of LM was made in 60% vs. 72%) of cases. Most of the patients received surgical treatment (75% in 2005 vs. 97% in 2014), with 47% and 33% of excisions, respectively, remaining involved at the peripheral surgical margin. During the 10-year follow-up for the 2005 cohort, 7 of the 28 patients had recurrence (3 of whom already had previously involved margins following surgery). This study shows that making an accurate clinical diagnosis of LM remains a significant challenge. Although surgery has become the preferred management option, achieving clear excision remains difficult, with involved margins increasing the risk of local recurrence and need for further intervention.

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Surgical Margins for Lentigo Maligna, 2004

Cited by 16 publications

References 7 publications

Mohs Micrographic Surgery is Accurate 95.1% of the Time for Melanoma In Situ: A Prospective Study of 167 Cases

Mohs Micrographic Surgery is Accurate 95.1% of the Time for Melanoma In Situ: A Prospective Study of 167 Cases

Mohs surgery and margin control in the treatment of melanoma

Diagnosis and management of lentigo maligna: an observational study comparing 2005 with 2014 data in one institution

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