Original articleFrequency of residual melanoma in wide local excision (WLE) specimens after complete excisional biopsy
Section snippets
Methods
Institutional ethics board approval was obtained and all patients involved provided written informed consent. A total of 807 consecutive WLE of primary cutaneous melanomas diagnosed on complete excisional biopsy specimen were identified from the prospectively maintained database of the Victorian Melanoma Service in the period between January 2000 and July 2011. Complete excisional biopsy was defined as a formal excision in which the melanoma was removed with clinically and histologically clear
Results
The median age at diagnosis was 59 years (interquartile range [IQR] 47-71 years) and there was a male predominance (56.8%). Median Breslow thickness was 1.05 mm (IQR 0.4-2.2 mm). Median diameter of the primary tumor was 7.0 mm (IQR 6.0-12.0 mm). SSM was the commonest subtype (68.6%), followed by nodular melanoma (17.1%), LM (8.7%), and desmoplastic melanoma (2.3%). Most melanomas were pigmented (89.6%) and nonulcerated (80.9%). In decreasing order of frequency, melanomas were located on the
Discussion
This study illustrates that it is not uncommon to find melanoma in WLE specimens after a clinically and histologically clear excisional biopsy specimen. We found melanoma in 4.2% of WLE specimens after complete excisional biopsy, a figure that is higher compared with previously reported rates of 0% to 3.6%.2, 3, 4 The figure of 4.2% may underestimate the true prevalence of melanoma persisting in such WLE specimens because, although we observed standard histologic practice, very small foci of
Conclusions
In this study we have demonstrated that after a clinically and histologically complete excisional biopsy, it is not uncommon to find residual melanoma in the WLE specimen. Patients with LM subtype melanomas are most at risk. Our findings indicate that the procedure of WLE is most important therapeutically for its role in controlling the primary melanoma, rather than in controlling local metastatic recurrence.
References (19)
- et al.
Residual melanoma after an excisional biopsy is an independent prognostic factor for local recurrence and overall survival
Eur J Surg Oncol
(2014) - et al.
Malignant melanoma re-excision specimens: is there a need for histopathological analysis?
J Plast Reconstr Aesthet Surg
(2008) Lentigo maligna and lentigo maligna melanoma
J Am Acad Dermatol
(1995)- et al.
Progression to invasive melanoma from malignant melanoma in situ, lentigo maligna type
Hum Pathol
(2000) - et al.
A simulation study of the number of events per variable in logistic regression analysis
J Clin Epidemiol
(1996) - et al.
A follow-up study to investigate the efficacy of initial treatment of lentigo maligna with surgical excision
Br J Plast Surg
(2002) Clinical practice guidelines for the management of melanoma in Australia and New Zealand
(2008)- et al.
Malignant melanoma re-excision specimens–how many blocks?
Histopathology
(1998) - et al.
The time from diagnostic excision biopsy to wide local excision for primary cutaneous malignant melanoma may not affect patient survival
Br J Dermatol
(2002)
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Funding sources: None.
Conflicts of interest: None declared.