Ständer S, Assmann K, Nashan D, Wigbels B, Luger T, Metze D
Universitäts-Hautklinik der Westfälischen Wilhelms-Universität Münster.
Hautarzt. 2000 Nov;51(11):826-32. doi: 10.1007/s001050051225.
Malignant melanomas on sun-exposed skin are often poorly circumscribed and thus recur frequently. The aim of our clinical trial was to compare conventional to a modified micrographic surgery of primary melanoma.
PATIENTS/METHODS: 28 patients with in-situ (n = 7) and invasive (n = 21) melanoma were treated with conventional surgical excision with wide margins; eight of these patients developed a local recurrence. In comparison, 20 patients with primary in-situ (n = 7) and invasive (n = 13) melanoma as well as four patients with recurrence after conventional surgery underwent modified micrographic surgery with delayed closure of the wound.
Paraffin specimens of the margins revealed in half of the patients remnants of melanoma although excision was extended to non-lesional skin. Within a mean follow-up period of 21.3 months, none of our patients treated by modified surgery developed a recurrence.
Local recurrencies of melanoma on sun exposed skin may be avoided by means of a modified micrographic surgery using permanent histologic sections.
暴露于阳光下皮肤的恶性黑色素瘤通常边界不清，因此复发频繁。我们临床试验的目的是比较原发性黑色素瘤的传统手术与改良显微外科手术。
患者/方法：28例原位（n = 7）和浸润性（n = 21）黑色素瘤患者接受了带宽切缘的传统手术切除；其中8例患者出现局部复发。相比之下，20例原发性原位（n = 7）和浸润性（n = 13）黑色素瘤患者以及4例传统手术后复发的患者接受了改良显微外科手术，并延迟伤口闭合。
尽管切除范围已扩大至非病变皮肤，但在一半患者的切缘石蜡标本中仍发现黑色素瘤残留。在平均21.3个月的随访期内，接受改良手术治疗的患者均未出现复发。
采用永久性组织切片的改良显微外科手术可避免暴露于阳光下皮肤黑色素瘤的局部复发。
