Surgical margins for lentigo maligna and lentigo maligna melanoma - The technique of mapped serial excision
Surgical margins for lentigo maligna and lentigo maligna melanoma - The technique of mapped serial excision
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DOI：
10.1001/archderm.140.9.1087
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发表时间：
2004-09-01
影响因子：
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通讯作者：
Malhotra, R
中科院分区：
文献类型：
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作者：
Huilgol, SC;Selva, D;Malhotra, R
目的：评估标测系列切除(MSE)技术切除恶性雀斑(LM)和恶性黑色素瘤(LMM)所需的切缘范围，并评估MSE的疗效。设计：一项干预性、前瞻性、非对照病例系列。地点：三级转诊，皮肤科外科。患者：1993年3月1日至2002年10月31日连续接受MSE的头颈部恶性黑色素瘤或LMM患者。干预：LM或LMM的MSE。主要观察指标：根治性切除5 mm节段数、根治术后复发情况。结果：共治疗161例LMS或LMM。30%(37/125)的LMS需要超过5 mm的边距。对于布雷斯洛厚度小于1 mm的LMM，12%(4/32)需要超过10 mm的边距。对于原发肿瘤，20%的LMS(91例中18例)需要超过5 mm的边界，而10%的Breslow厚度小于1 mm的LMM(21例中有2例)需要超过10 mm的边界。对于复发的肿瘤，56%的LMS(19/34)需要超过5 mm的边缘。平均随访38个月(5~100个月)，MSE后复发4例(2%)。术后5年的外推复发率为5.0%。结论：目前推荐的5 mm切缘和10 mm切缘的LMM在Breslow厚度小于1 mm时往往是不够的。我们的结果证明了切缘控制切除的重要性，特别是在复发的病变中。MSE的使用提供了高治愈率，与组织保护相结合。
Objectives: To assess the margins required for excision of lentigo maligna (LM) and lentigo maligna melanoma (LMM) by the technique of mapped serial excision (MSE), and to assess the efficacy of MSE.Design: An interventional, prospective, noncontrolled case series.Setting: Tertiary referral, dermatologic surgery unit.Patients: Consecutive patients with head and neck LM or LMM who underwent MSE between March 1, 1993, and October 31, 2002.Intervention: The MSE of LM or LMM. Main Outcome Measures: The number of 5-mm levels for excision of LM and LMM and recurrence.Results: One hundred sixty-one LMs or LMMs in 155 patients were treated. Thirty percent (37 of 125) of LMs required more than 5-mm margins. For LMMs less than I mm in Breslow thickness, 12% (4/32) required more than 10-mm margins. For primary tumors, 20% of LMs (18 of 91) required more than 5-mm margins, while 10% of LMMs less than 1 mm in Breslow thickness (2 of 21) required more than a 10-mm margin. For recurrent tumors, 56% of LMs (19/34) required more than a 5-mm margin. Mean follow-up of 38 months (range, 5-100 months) showed 4 recurrences (2%) after MSE. The extrapolated recurrence at 5 years was 5.0%.Conclusions: The current recommendations of 5-mm margins for LM and 10-mm margins for LMM less than I mm in Breslow thickness are often insufficient. Our results demonstrate the importance of margin-controlled excision, particularly in recurrent lesions. The use of MSE offers a high cure rate, in conjunction with tissue conservation.