Abstract
The Dutch melanoma guideline advises to examine one central block of the re-excision scar in case of a complete primary excision. To increase the evidence for this recommendation, we re-evaluated how often residual melanoma was found in re-excision specimens of a large series of completely excised melanomas. Of 1,209 Dutch melanoma cases, pathology reports of primary excisions were reviewed. Presence of melanoma in the margins was scored. All melanomas with a complete primary excision were included and pathology reports of re-excisions were reviewed. Presence of residual melanoma in the re-excision specimen and the number of blocks were scored. Slides of re-excision specimens containing residual melanoma were reviewed. Eventually, in four out of 812 melanomas (0.5 %) with a complete primary excision, residual melanoma was found in the re-excision specimen. The free margins of the primary melanomas in these cases ranged from 0.5–3.5 mm. In one case, the margin for melanoma in situ was 0.2 mm. In <1 % of initially completely excised melanomas, residual melanoma was found in the re-excision specimen. Histopathological examination of these re-excision specimens may not be cost-efficient. Our findings even imply that a re-excision could safely be omitted in selected cases of completely excised melanomas.
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Day CL Jr, Harrist TJ, Gorstein F, Sober AJ, Lew RA, Friedman RJ, Pasternack BS, Kopf AW, Fitzpatrick TB, Mihm MC Jr (1981) Malignant melanoma. Prognostic significance of “microscopic satellites” in the reticular dermis and subcutaneous fat. Ann Surg 194(1):108–112
Kelly JW, Sagebiel RW, Calderon W, Murillo L, Dakin RL, Blois MS (1984) The frequency of local recurrence and microsatellites as a guide to reexcision margins for cutaneous malignant melanoma. Ann Surg 200(6):759–763
Cohn-Cedermark G, Rutqvist LE, Andersson R, Breivald M, Ingvar C, Johansson H, Jonsson PE, Krysander L, Lindholm C, Ringborg U (2000) Long term results of a randomized study by the Swedish Melanoma Study Group on 2-cm versus 5-cm resection margins for patients with cutaneous melanoma with a tumor thickness of 0.8-2.0 mm. Cancer 89(7):1495–1501
Gillgren P, Drzewiecki KT, Niin M, Gullestad HP, Hellborg H, Mansson-Brahme E, Ingvar C, Ringborg U (2011) 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: a randomised, multicentre trial. Lancet 378(9803):1635–1642. doi:10.1016/S0140-6736(11)61546-8
Khayat D, Rixe O, Martin G, Soubrane C, Banzet M, Bazex JA, Lauret P, Verola O, Auclerc G, Harper P, Banzet P, French Group of Research on Malignant M (2003) Surgical margins in cutaneous melanoma (2 cm versus 5 cm for lesions measuring less than 2.1-mm thick). Cancer 97(8):1941–1946. doi:10.1002/cncr.11272
Veronesi U, Cascinelli N (1991) Narrow excision (1-cm margin). A safe procedure for thin cutaneous melanoma. Arch Surg 126(4):438–441
Veerbeek L, Kruit WH, de Wilt JH, Mooi WJ, Bergman W (2013) Revision of the national guideline ‘Melanoma’. Ned Tijdschr Geneeskd 157(12):A6136
Martin HM, Birkin AJ, Theaker JM (1998) Malignant melanoma re-excision specimens—how many blocks? Histopathology 32(4):362–367
McGoldrick RB, Ng D, Sawyer A, Mackey S, Vadodaria S, Powell BW (2008) Malignant melanoma re-excision specimens: is there a need for histopathological analysis? J Plast Reconstr Aesthet Surg 61(8):983–984. doi:10.1016/j.bjps.2007.11.051
Johnson R, Sviland L (1998) Is extensive histological examination of wide excision specimens necessary following a diagnosis of melanoma. Histopathology 32(4):379–380
Dummer R, Hauschild A, Guggenheim M, Keilholz U, Pentheroudakis G, Group EGW (2012) Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol Off J Eur Soc Med Oncol 23(Suppl 7):vii86–91. doi:10.1093/annonc/mds229
Garbe C, Peris K, Hauschild A, Saiag P, Middleton M, Spatz A, Grob JJ, Malvehy J, Newton-Bishop J, Stratigos A, Pehamberger H, Eggermont AM, European Dermatology F, European Association of D-O, European Organization of R, Treatment of C (2012) Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline–Update 2012. Eur J Cancer 48(15):2375–2390. doi:10.1016/j.ejca.2012.06.013
Marsden JR, Newton-Bishop JA, Burrows L, Cook M, Corrie PG, Cox NH, Gore ME, Lorigan P, MacKie R, Nathan P, Peach H, Powell B, Walker C, British Association of Dermatologists Clinical Standards U (2010) Revised U.K. guidelines for the management of cutaneous melanoma 2010. Br J Dermatol 163(2):238–256. doi:10.1111/j.1365-2133.2010.09883.x
Pflugfelder A, Kochs C, Blum A, Capellaro M, Czeschik C, Dettenborn T, Dill D, Dippel E, Eigentler T, Feyer P, Follmann M, Frerich B, Ganten MK, Gartner J, Gutzmer R, Hassel J, Hauschild A, Hohenberger P, Hubner J, Kaatz M, Kleeberg UR, Kolbl O, Kortmann RD, Krause-Bergmann A, Kurschat P, Leiter U, Link H, Loquai C, Loser C, Mackensen A, Meier F, Mohr P, Mohrle M, Nashan D, Reske S, Rose C, Sander C, Satzger I, Schiller M, Schlemmer HP, Strittmatter G, Sunderkotter C, Swoboda L, Trefzer U, Voltz R, Vordermark D, Weichenthal M, Werner A, Wesselmann S, Weyergraf AJ, Wick W, Garbe C, Schadendorf D (2013) Malignant melanoma S3-guideline “diagnosis, therapy and follow-up of melanoma. J Dtsch Dermatol Ges J Ger Soc Dermatol 11(Suppl 6):1–116. doi:10.1111/ddg.12113_suppl, 111–126
Norris WMD (1857) Eight cases of melanosis with … remarks on that disease. Longman, London
Handley WS (1907) The pathology of melanotic growths in relation to their operative treatment. Lancet 1:927–933
Wong CK (1970) A study of melanocytes in the normal skin surrounding malignant melanomata. Dermatologica 141(3):215–225
Kimyai-Asadi A, Katz T, Goldberg LH, Ayala GB, Wang SQ, Vujevich JJ, Jih MH (2007) Margin involvement after the excision of melanoma in situ: the need for complete en face examination of the surgical margins. Dermatol Surg Off Publ Am Soc Dermatol Surg 33(12):1434–1439. doi:10.1111/j.1524-4725.2007.33313.x, discussion 1439–1441
Kroon BB, Bergman W, Coebergh JW, Ruiter DJ (1997) 2nd revised consensus skin melanoma. De Nederlandse Melanoom Werkgroep. Ned Tijdschr Geneeskd 141(42):2015–2019
Rampen FH, Ruiter DJ, Kroon BB, Rumke P (1990) Revised consensus melanoma of the skin. Ned Tijdschr Geneeskd 134(42):2031–2033
Rampen FH, Rumke P (1985) Consensus melanoma of the skin. Ned Tijdschr Geneeskd 129(17):785–788
van Everdingen JJ, van der Rhee HJ, Koning CC, Nieweg OE, Kruit WH, Coebergh JW, Ruiter DJ, Nederlandse Melanoom W (2005) Guideline ‘Melanoma’ (3rd revision). Ned Tijdschr Geneeskd 149(33):1839–1843
Schouten LJ, Straatman H, Kiemeney LA, Gimbrere CH, Verbeek AL (1994) The capture-recapture method for estimation of cancer registry completeness: a useful tool? Int J Epidemiol 23(6):1111–1116
Hollestein LM, van den Akker SA, Nijsten T, Karim-Kos HE, Coebergh JW, de Vries E (2012) Trends of cutaneous melanoma in The Netherlands: increasing incidence rates among all Breslow thickness categories and rising mortality rates since 1989. Ann Oncol Off J Eur Soc Med Oncol 23(2):524–530. doi:10.1093/annonc/mdr128
Kalady MF, White RR, Johnson JL, Tyler DS, Seigler HF (2003) Thin melanomas: predictive lethal characteristics from a 30-year clinical experience. Ann Surg 238(4):528–535. doi:10.1097/01.sla.0000090446.63327.40, discussion 535–527
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The authors would like to thank the Dutch Cancer Society and the Radboud university medical center for their financial support of the study.
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de Waal, A.C., Vossen, R., Aben, K.K.H. et al. Limited role for histopathological examination of re-excision specimens of completely excised melanomas. Virchows Arch 465, 225–231 (2014). https://doi.org/10.1007/s00428-014-1595-5
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DOI: https://doi.org/10.1007/s00428-014-1595-5