Risk Factors Predicting Positive Margins at Primary Wide Local Excision of Cutaneous Melanoma

作者：Aaron R. Mangold, Ryan Thomas Skinner, Amylou C. Dueck, Aleksander Sekulic, Barbara A. Pockaj · 发表于：Dermatologic Surgery · 年份：2016 · DOI：10.1097/dss.0000000000000702 · 被引用次数：38 · 研究领域：Cutaneous Melanoma Detection and Management、Nonmelanoma Skin Cancer Studies、Melanoma and MAPK Pathways

BACKGROUND: A small percentage of patients will have positive histological margins after primary wide local excision (WLE) of cutaneous melanoma (CM). Risk factors that predict marginal involvement at WLE remain unclear. OBJECTIVE: To identify risk factors associated with positive margins after WLE of CM. MATERIALS AND METHODS: A retrospective review of patients treated at a single institution for CM with sentinel lymph node biopsy from 1997 to 2011 was conducted. RESULTS: Positive margins occurred in 6% of patients. Patients with positive margins were older (72.4 vs 60.7, p < .001), had thicker tumors (3.6 vs 1.9 mm, p < .001), and often involved the head and neck region (p < .001). Patients with positive margins at WLE had positive margins on initial biopsy (p = .012) and a higher rate of a melanoma in situ component on initial biopsy (24% vs 11%, p = .02). The 5-year local recurrence rate was significantly different between those with positive and negative margins at WLE (16.0% vs 6.9%; p = .047). CONCLUSION: Positive margins after WLE are uncommon. When a patient has multiple risk factors for positive margins at WLE, histologically clear margins should be obtained through mapped serial excision or Mohs micrographic surgery.