Five-Year Outcomes of Wide Excision and Mohs Micrographic Surgery for Primary Lentigo Maligna in an Academic Practice Cohort
Five-Year Outcomes of Wide Excision and Mohs Micrographic Surgery for Primary Lentigo Maligna in an Academic Practice Cohort
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DOI：
10.1097/dss.0000000000000248
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发表时间：
2015-02-01
影响因子：
2.4
通讯作者：
Roenigk, Randall K.
中科院分区：
文献类型：
--
作者：
Hou, Jennifer L.;Reed, Kurtis B.;Roenigk, Randall K.
背景 5 毫米边缘的广泛局部切除是恶性雀斑样痣 (LM) 的护理标准。莫氏显微手术（MMS）越来越多地用于治疗这种肿瘤。目的研究作者使用这两种方法的经验。材料和方法对1995年1月1日至2005年12月31日在作者所在机构治疗的原发性LM病例进行回顾性研究。主要结局指标是复发和复发治疗后的结局。 结果 407 例患者总共治疗了 423 个 LM 病灶：269 例（64%）采用广泛切除，154 例（36%）采用 MMS。在 MMS 组（主要是较大的头颈部病变，临床边缘不明显），复发率为 154 例中的 3 例（1.9%）。在广泛切除组（主要是较小的、非头颈部的或更明显的病变）中，复发率为 269 例中的 16 例（5.9%）。 16 例复发均经过活检证实并进行了手术治疗：6 例通过标准切除，10 例通过 MMS。 结论 这项 LM 手术治疗的后续研究显示了广泛切除和 MMS 的良好效果。由于这是一项非随机回顾性研究，因此无法对两种治疗方法进行直接比较。当复发发生时，重复手术，无论是标准切除还是 MMS，通常足以提供彻底治愈。
BACKGROUNDWide local excision with 5-mm margins is the standard of care for lentigo maligna (LM). Mohs micrographic surgery (MMS) is used increasingly to treat this tumor.OBJECTIVETo study the authors' experience with these 2 approaches.MATERIALS AND METHODSPrimary LM cases treated at the authors' institution from January 1, 1995, through December 31, 2005, were studied retrospectively. Main outcome measures were recurrence and outcomes after treatment for recurrence.RESULTSIn total, 423 LM lesions were treated in 407 patients: 269 (64%) with wide excision and 154 (36%) with MMS. In the MMS group (primarily larger head and neck lesions with indistinct clinical margins), recurrence rates were 3 of 154 (1.9%). In the wide excision group (primarily smaller, nonhead and neck, or more distinct lesions), recurrence rates were 16 of 269 (5.9%). Each of the 16 recurrences was biopsy proven and treated surgically: 6 by standard excision and 10 by MMS.CONCLUSIONThis follow-up study of LM surgical treatments shows excellent outcomes for wide excision and MMS. Because this is a nonrandomized retrospective study, no direct comparisons between the 2 treatments can be made. When recurrences occurred, repeat surgery, either standard excision or MMS, was usually sufficient to provide definitive cure.