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Low recurrence rates in staged excision of head, neck melanomas
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Staged excision of melanomas arising in chronically sun-damaged skin on the head and neck had low local recurrence rates and high patient satisfaction, according to study results published in JAMA Dermatology.
Researchers from the University of Michigan Medical School, Ann Arbor, queried 806 patients with a melanoma diagnosis who had undergone staged excision with formalin-fixed permanent section margin control between Oct. 8, 1997, and Dec. 31, 2006.
Seventeen local recurrences were found among the 834 unique staged excision procedures. The researchers defined local recurrence as a new clinical lesion developing within 5 mm of the surgical scar with biopsy results revealing invasive melanoma, melanoma in situ or atypical junctional melanocytic hyperplasia.
Local recurrence rates were estimated to be 1.4% at 5 years, 1.8% at 7.5 years and 2.2% at 10 years. There was a 9% increase in the local recurrence rate for each 50 mm2 increase in the size of the clinical lesion (HR = 1.09; 95% CI, 1.02-1.15; P = .02).
The mean margin from lesion clearance for melanoma in situ was 9.3 mm, with clear margins after 5 mm or less in 232 excisions and after 10 mm or less in 420 excisions. The mean margin from lesion clearance for invasive melanoma was 13.7 mm, with clear margins after 5 mm in 8 excisions and after 10 mm or less in 141 excisions.
Of the 320 patients who completed the outcome assessment survey, 271 reported being very satisfied and 30 reported being somewhat satisfied. The researchers found no association between subjective reconstructive outcomes and the size of the area reconstructed.
“The low local recurrence rates and patient satisfaction obtained with this technique are the result of the collaborative efforts of a multidisciplinary approach with experts in excision technique, histopathologic analysis, and reconstruction of each lesion,” the researchers wrote. “Our results should be interpreted as one method to achieve high rates of local control and may serve as a reference point for future practice guidelines.” – by Talitha Bennett
Disclosure: The researchers report no relevant financial disclosures.
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