An assessment of histological margins and recurrence of melanoma in situ.
An assessment of histological margins and recurrence of melanoma in situ.
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DOI：
10.1097/gox.0000000000000272
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发表时间：
2015-02
期刊：
影响因子：
--
通讯作者：
Kelly JL
中科院分区：
文献类型：
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作者：
Joyce KM;Joyce CW;Jones DM;Donnellan P;Hussey AJ;Regan PJ;Kelly JL
原位黑色素瘤（MIS）占所有黑色素瘤的27%。MIS没有转移的可能性，目的应该是完全切除病变，并有明确的组织学边界，尽管边界清除仍不明确。我们的目的是评估MIS的组织学切除边缘与复发和进展为侵袭性疾病的关系。我们使用前瞻性维护的数据库分析了2008年12月至2014年1月5年间我院所有通过广泛局部切除或分期切除的MIS患者。临床病理细节包括患者人口统计学、病变解剖部位、黑色素瘤亚型、组织学切除边缘和复发。在此期间，共有410例患者切除了MIS，其中大多数是lentigo恶性亚型（79%）。平均组织学切除切缘3.7 mm。复发率2.2%(9/410)，中位随访23个月。恶性Lentigo的复发率与非Lentigo MIS相似（2.3% vs 1.2%） （P = 0.69）。复发者的平均切除幅度为1.9 mm，而未复发者的平均切除幅度为3.8 mm。组织学切缘≤3.00 mm的MIS复发率为3.8%，而组织学切缘≤3.00 mm的MIS复发率为0.5% （P = 0.03）。1例MIS复发为侵袭性疾病。在使用大面积局部切除或分期切除MIS的机构中，需要bb0 3.0 mm的组织学切缘才能达到低复发率。
Melanoma in situ (MIS) accounts for up to 27% of all melanomas. MIS has no metastatic potential and the aim should be to excise the lesion completely with a clear histological margin, although margin clearance remains undefined. We aimed to assess the relation of histological excision margins of MIS to recurrence and progression to invasive disease. We analyzed all patients with MIS excised by wide local excision or staged excision in our institution over a 5-year period from December 2008 to January 2014 using a prospectively maintained database. Clinicopathologic details included patient demographics, anatomical site of lesion, melanoma subtype, histological excision margin, and recurrence. A total of 410 patients had MIS excised during this time, the majority of which were lentigo maligna subtype (79%). The average histological excision margin was 3.7 mm. The rate of recurrence was 2.2% (9/410), with a median follow-up of 23 months. Lentigo maligna had a similar rate of recurrence to non-lentigo MIS (2.3% vs 1.2%) (P = 0.69). The mean excision margin of those that recurred was 1.9 mm compared with an average of 3.8 mm in those that did not. The rate of recurrence of MIS with histological excision margin ≤3.00 mm was 3.8% compared with 0.5% in those with a histological margin >3.00 mm (P = 0.03). One case of MIS recurred as invasive disease. At institutions using wide local excision or staged excision for MIS, a histological margin of >3.0 mm is required to achieve a low recurrence rate.