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Staged melanoma excision requires larger margins for tumor clearance and results in low rates of recurrence

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Abstract

There is controversy regarding the optimal surgical modality and ideal recommended margins for treating melanoma in situ (MIS) and invasive melanoma (IM). Although wide local excision is recommended, staged excision offers excellent margin control and low recurrence rates. In this manuscript, we reviewed a 10-year experience of staged excisions for the treatment of MIS and IM. A retrospective review was performed of 130 MIS and 32 IM cases treated with staged excision from April 2012 to April 2022. Staged excision was performed on the head and neck in 102 (79%) MIS and 23 (72%) IM cases. Approximately 10% of cases required surgical margins above the current recommendations (11 (9%) MIS and 6 (19%) IM). Twenty-three (19%) MIS and 7 (22%) IM cases required more than one excision to obtain clearance. Recurrence rates among MIS and IM were 0.0% and 0.6%, respectively. Upstaging occurred in 5 (4%) MIS and 7 (22%) IM cases. Complex repairs were performed on 82 (63%) MIS and 17 (53%) IM cases. Our findings revealed that staged excision provides effective margin control and low recurrence rates. Approximately 10% of patients required margins greater than the current recommendations, leading to larger defects and more complex repairs.

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Abbreviations

MIS:

Melanoma in situ

IM:

Invasive melanoma

MMS:

Mohs micrographic surgery

NCCN:

National Comprehensive Cancer Network

cm:

Centimeters

BD:

Breslow depth

mm:

Millimeter

NYU:

New York University

AJCC:

American Joint Committee

AIMP:

Atypical intraepidermal melanocytic proliferation

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Acknowledgements

There was no financial support received. All authors contributed to writing and editing the manuscript.

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Authors and Affiliations

  1. The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 222 East 41st Street, New York, NY, 10016, USA

    Jaclyn Rosenthal Himeles, Maressa C. Criscito, Nayoung Lee, Mary L. Stevenson & John A. Carucci

Authors
  1. Jaclyn Rosenthal Himeles
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  2. Maressa C. Criscito
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  3. Nayoung Lee
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  4. Mary L. Stevenson
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  5. John A. Carucci
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Contributions

J.R.H collected the data, analyzed and interpreted the data, and drafted the main manuscript. M.C and J.C developed the conception and design of the work. All authors reviewed the manuscript.

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Correspondence to John A. Carucci.

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Himeles, J.R., Criscito, M.C., Lee, N. et al. Staged melanoma excision requires larger margins for tumor clearance and results in low rates of recurrence. Arch Dermatol Res 315, 933–942 (2023). https://doi.org/10.1007/s00403-022-02426-z

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  • DOI: https://doi.org/10.1007/s00403-022-02426-z

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