Original article
Frequency of residual melanoma in wide local excision (WLE) specimens after complete excisional biopsy

https://doi.org/10.1016/j.jaad.2015.08.065Get rights and content

Objective

We sought to better understand the role of wide local excision (WLE) in the treatment of cutaneous melanoma by analyzing residual or locally metastatic disease in WLE specimens of melanomas initially diagnosed with a complete excisional biopsy.

Methods

This was a retrospective review of 807 consecutive WLEs of melanomas diagnosed after complete excisional biopsy. All specimens were reviewed by a single dermatopathologist. Risk of residual or locally metastatic disease was analyzed using univariate and multivariate logistic regression models.

Results

In the 807 WLE specimens, further melanoma was found in 34 cases (4.2%; 95% confidence interval [CI] 2.9-5.8). Residual primary melanoma was found in 33 of these. On univariate analysis, features associated with residual or locally metastatic disease were histologic subtype (odds ratio 3.0; 95% CI 1.3-7.1, P = .01) and tumor location (odds ratio 7.3; 95% CI 2.0-26.6, P < .01). On multivariate analysis, lentigo maligna was independently associated with melanoma remaining in WLE specimens (odds ratio 2.7; 95% CI 1.0-7.3, P = .04).

Conclusion

Residual melanoma in WLE specimens after histologically assessed complete excisional biopsy is not uncommon. Patients with lentigo maligna 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 tumor, rather than in preventing local metastatic recurrence.

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)

There are more references available in the full text version of this article.

Cited by (22)

  • Mohs micrographic surgery versus wide local excision for eyelid melanoma: An analysis of a national database

    2022, Journal of Plastic, Reconstructive and Aesthetic Surgery
    Citation Excerpt :

    Eyelid melanomas are treated surgically often by wide local excision (WLE), whereby the tumor is excised around a recommended margin that is analyzed histologically for clearance. Studies examining WLE in other anatomic locations have found that bread-loafing technique results in less than 1% of the surgical margin examined, leading to increased recurrence.14-16 Alternatively, Mohs micrographic surgery (MMS) is a cost-effective and tissue-sparing technique allowing for examination of nearly 100% of the margins.17,18

  • Residual melanoma in wide local excision specimens after ‘complete’ excision of primary cutaneous in situ and invasive melanomas

    2022, Pathology
    Citation Excerpt :

    The objective is to achieve adequate clearance margins.1–4 Although WLE is thought to have a therapeutic benefit by controlling local disease, it may not impact overall survival.2,5–7 It is a relatively infrequent occurrence to find residual melanoma in the WLE specimen after a prior excision-biopsy that has shown complete clinical and histological excision of a primary cutaneous melanoma.

  • Comparison of surgical margins for lentigo maligna versus melanoma in situ

    2019, Journal of the American Academy of Dermatology
    Citation Excerpt :

    The University of Pennsylvania has reported that lesions on the head and neck are 2 times more likely than other sites to have subclinical spread beyond 5 mm.17 Multiple studies have found head and neck location to be associated with subclinical extension, sometimes more than 1 cm (Table II).1-19,35-38 The possibility of subclinical extension beyond 1 cm is not new.

  • Lentigo Maligna, Macules of the Face, and Lesions on Sun-Damaged Skin: Confocal Makes the Difference

    2016, Dermatologic Clinics
    Citation Excerpt :

    However, residual disease after surgical excision is common, indicating failure of margin assessment. In a recent retrospective review of 807 cases of residual melanoma in wide local excision after complete surgical resection, LM was the subtype at greatest risk for persistent disease despite reportedly clear margins.59 RCM is well suited to defining the margins of ill-defined and difficult lesions even when they are lightly colored or amelanotic.60–62

View all citing articles on Scopus

Funding sources: None.

Conflicts of interest: None declared.

View full text