Treating melanoma <i>in situ</i> and lentigo maligna with Mohs micrographic surgery in Australia

Foxton, Glen; Elliott, Timothy G; Litterick, Kelly A

doi:10.1111/ajd.12845

Cited by 20 publications

(43 citation statements)

References 24 publications

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“…On the basis of their finding that only 89.1% of MIS patients had a complete excision with 6 mm margins, the authors recommended surgical margins of 9 mm for MIS of the head/neck. Foxton et al reported that a mean clinical margin of 6.7 mm was necessary in their cohort of 62 patients with MIS or LM, predominantly located on the head/neck ( n = 55, 89%) [ 19 ]. They found that only 68% of patients achieved clearance with 6 mm margins, 92% with 9 mm margins, and 100% with 12 mm margins.…”

Section: Resultsmentioning

confidence: 99%

Melanoma In Situ: A Critical Review and Re-Evaluation of Current Excision Margin Recommendations

et al. 2021

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Most international clinical guidelines recommend 5-10 mm clinical margins for excision of melanoma in situ (MIS). While the evidence supporting this is weak, these guidelines are generally consistent. However, as a result of the high incidence of subclinical extension of MIS, especially of the lentigo maligna (LM) subtype, wider margins will often be needed to achieve complete histologic clearance. In this review, we assessed all available contemporary evidence on clearance margins for MIS. No randomized trials were identified and the 31 non-randomized studies were largely retrospective reviews of single-surgeon or single-institution experiences using Mohs micrographic surgery (MMS) for LM

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Section: Resultsmentioning

confidence: 99%

Melanoma In Situ: A Critical Review and Re-Evaluation of Current Excision Margin Recommendations

et al. 2021

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“…Low recurrence rates <2% have been reported in the use of MMS for MIS and melanoma in a number of studies . However, there have been few published direct comparative studies between WLE and MMS techniques for surgical treatment of MIS.…”

Section: Discussionmentioning

confidence: 99%

“…Survival rates at 5-, 10, and 15-year follow-up were similar between WLE versus MMS groups for MIS ( Low recurrence rates <2% have been reported in the use of MMS for MIS and melanoma in a number of studies. [11][12][13][14][15][16][17][18] which allows for tissue preservation. Given that maximal amount of normal skin is preserved and the smallest surgical defect possible is obtained with MMS, it should be considered when lesions are located in areas of anatomical and cosmetic significance.…”

Section: Survival Outcomesmentioning

confidence: 99%

Mohs micrographic surgery versus wide local excision for melanoma in situ: analysis of a nationwide database

Phan

Loya

2019

Int J Dermatology

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Background With the rising incidence of melanoma in situ (MIS) or cutaneous melanoma, there is an increasing emphasis on the need to understand optimal treatment strategies. The current standard of surgical care is wide local excision (WLE). Alternative surgical techniques have been proposed including Mohs micrographic surgery (MMS). We aimed to compare survival rates following WLE versus MMS surgery for MIS. Methods We performed a retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) cancer registry. 24,515 cases of WLE were identified and compared with 4122 cases of MMS surgery for MIS. Results There was a significantly higher proportion of elderly patients aged ≥75 years in the MMS group compared to WLE (23.3% vs. 15.3%). The proportion of females was higher for WLE compared to MMS (48.8% vs. 40%). Facial MIS tumors were significantly higher for MMS, as were scalp/neck tumors. After adjustment for confounding factors, there was no significant difference in cancer‐specific survival (HR 0.928, 95% CI 0.596–1.446, P = 0.74) and overall survival (HR 1.006, 95% CI 0.896–1.129, P = 0.924). Conclusion Adjusted analyses demonstrated no differences in overall survival or cancer‐specific survival between MIS patients treated with MMS compared with WLE.

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“…In addition to conventional excision, surgical techniques such as staged excision or Mohs micrographic surgery can be used for the treatment of lentigo maligna in problematic areas in order to achieve margin control [8][9][10] . Less invasive treatment options may be considered, depending on the location and size of the tumor, advanced age, and the morbidity of the patient.…”

Section: Introductionmentioning

confidence: 99%

The use of 2940‐nm ER:YAG laser for the treatment of lentigo maligna

Fikrle

Divišová

Šuchmannová

et al. 2019

J Deutsche Derma Gesell

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ZusammenfassungZiele: Die Lentigo maligna ist ein bei älteren Patienten häufig auftretendes malignes Carcinoma in situ mit einem geringen invasiven Progressionsrisiko. Da ein chirurgisches Vorgehen schwierig sein kann oder vom Patienten abgelehnt wird, besteht ein Bedarf an nichtoperativen Therapieoptionen wie beispielsweise eine Laserbehandlung. Patienten und Methoden: Wir berichten über 17 Patienten, die wegen einer histopathologisch gesicherten Lentigo maligna mit einem 2940 nm Er:YAG-Laser (Erbium-dotierter Yttrium-Aluminium-Granat-Laser) behandelt wurden. Die Ablation der Läsionen schloss einen Sicherheitsabstand von 5 mm ein und wurde unter Lokalanästhesie mit überlappenden Laserspots (3,5 mm), einer Energiedichte von 6,5 J/cm 2 und einer Wiederholungsrate von 5 Hz durchgeführt. Trat im abladierten Bereich während der nachfolgenden drei Monate eine klinisch erkennbare Pigmentierung auf, wurde die Läsion erneut behandelt. Bei allen Patienten erfolgte eine Nachkontrolle auf residuale oder rezidivierende Tumoren. Ergebnisse: Wir konnten bei allen 17 Patienten klinische Tumorfreiheit erreichen. Während der Nachsorge traten drei Rezidive auf (9, 30 und 36 Monate nach der Laserbehandlung). Alle Patienten waren mit dem Behandlungsverlauf und dem kosmetischen Ergebnis zufrieden. Die mittlere Dauer der Nachkontrolle betrug 28 Monate. Schlussfolgerungen: Die Laserablation ist eine interessante alternative Therapieoption bei Lentigo maligna. Sie kann in ausgewählten Fällen eingesetzt werden, bei denen ein chirurgisches Vorgehen kontraindiziert oder schwierig ist oder vom Patienten abgelehnt wird. SummaryObjectives: Lentigo maligna is a common in situ malignancy in elderly patients, with a low risk of progression to an invasive tumor. Surgical treatment may be complicated or refused. Non-surgical treatment options (such as lasers) may therefore be needed. Patients and Methods: We report on 17 patients treated with a 2940-nm Er:YAG (erbium-doped yttrium aluminum) laser for histopathologically confirmed lentigo maligna. The lesions were ablated with a 5 mm margin of adjacent skin under local anesthesia with a 3.5 mm overlapping spot, energy density of 6.5 J/cm 2 and a repetition rate of 5 Hz. If clinically visible pigmentation was seen in the ablated area during the following three months, the lesion was re-treated. All patients were followed up for residual or recurrent tumors. Results: We achieved clinical clearance in all 17 patients. There were three recurrences during the follow-up period (9, 30 and 36 months after laser therapy). All patients were satisfied with the treatment course and cosmetic outcome. The mean follow-up duration was 28 months.

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Treating melanoma in situ and lentigo maligna with Mohs micrographic surgery in Australia

Abstract: We provide the first Australian data on the use of Mohs micrographic surgery for melanoma.

Cited by 20 publications

References 24 publications

Melanoma In Situ: A Critical Review and Re-Evaluation of Current Excision Margin Recommendations

Melanoma In Situ: A Critical Review and Re-Evaluation of Current Excision Margin Recommendations

Mohs micrographic surgery versus wide local excision for melanoma in situ: analysis of a nationwide database

The use of 2940‐nm ER:YAG laser for the treatment of lentigo maligna

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