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One-step surgical removal of cutaneous melanoma with surgical margins based on preoperative ultrasound measurement of the thickness of the melanoma

  • Therapy
  • Published:
European Journal of Dermatology

Abstract

Background

Surgical margins of melanoma vary from 5 mm to 1 or 2 cm depending on histology thickness (Breslow). This approach usually requires two surgical steps: excisional biopsy and further reexcision according to histology thickness. A previous systematic review showed that measuring melanoma thickness with high-resolution ultrasound imaging equipment correlates well with histological measurement of melanoma thickness. Therefore, we routinely determined tumour sonographic thickness in order to perform surgery as a single step.

Objectives

To determine the proportion of patients who receive onestep surgery with adequate margins based on sonographic measurement of melanoma thickness and identify the reasons for differences between these two measurements.

Materials & Methods

A retrospective series of patients with melanoma, in which thickness was measured by ultrasound (20 MHz) from April 2007 to December 2015 prior to surgery.

Results

Ninety-nine melanomas were treated, of which 78 were removed in a single step with surgical margins based on sonometric thickness measurements; 71 of these (91%, 95% CI: 82-96) did not require reexcision, five had excessive margins, and two had insufficient margins. The correlation between the histometric and sonometric measurements was good; r=0.88. Significant absolute difference between sonometric and histometric measurementswas associated with thickness, ulceration, and size of tumours, based on bivariate analysis. Thickness remained the only significant factor based on multivariate analysis.

Conclusions

Measuring the thickness of melanoma with high-resolution ultrasound imaging equipment makes it possible to remove the melanoma in a single step with adequate margins in at least 82% of the cases in routine care.

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Authors and Affiliations

  1. Department of Dermatology, CHRU de Tours, Tours, France

    Laura Chaput, Youssef Mourtada, Loïc Vaillant & Laurent Machet

  2. Department of Epidemiology, CHRU de Tours, Tours, France

    Emeline Laurent

  3. Department of Facial and Plastic Surgery, CHRU de Tours, Tours, France

    Arnaud Pare & Aurélie Sallot

  4. CIT-IT, CHRU de Tours, Tours, France

    Frédéric Ossant & Frédéric Patat

  5. Inserm U930, Université Francois-Rabelais de Tours, Tours, France

    Frédéric Ossant, Loïc Vaillant, Frédéric Patat & Laurent Machet

Authors
  1. Laura Chaput
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  2. Emeline Laurent
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  3. Arnaud Pare
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  4. Aurélie Sallot
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  5. Youssef Mourtada
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  6. Frédéric Ossant
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  7. Loïc Vaillant
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  8. Frédéric Patat
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  9. Laurent Machet
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Corresponding author

Correspondence to Laurent Machet.

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Chaput, L., Laurent, E., Pare, A. et al. One-step surgical removal of cutaneous melanoma with surgical margins based on preoperative ultrasound measurement of the thickness of the melanoma. Eur J Dermatol 28, 202–208 (2018). https://doi.org/10.1684/ejd.2018.3298

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  • DOI: https://doi.org/10.1684/ejd.2018.3298

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