Bienert Tasha N, Trotter Martin J, Arlette John P
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
J Cutan Med Surg. 2003 Jan-Feb;7(1):25-30. doi: 10.1007/s10227-002-1161-7. Epub 2002 Nov 27.
The treatment of cutaneous malignant melanoma of the face presents a challenge to ensure eradication of disease with maximum preservation of tissue. Mohs micrographic surgery provides a means for histologically controlled removal of malignant melanoma.
This study evaluates the efficacy of Mohs micrographic surgery, at a single institution, for the treatment of facial melanoma and assesses the accuracy of margin control by frozen section techniques.
Ninety-seven patients with biopsy-confirmed melanoma in situ or invasive melanoma of the face were treated by Mohs micrographic surgery over a 6-year period. In 25 patients, tissue margins defined as negative for melanoma at the time of frozen section were re-evaluated on permanent section histology of formalin-fixed, paraffin-embedded tissue.
Ninety-two of 97 patients had followup information available (8-72 months; mean 33 months). There were no cases of local recurrence. Eighty-nine of the 92 patients were alive and well with no evidence of disease. One patient died of metastatic melanoma. In situ or invasive melanoma was not identified on permanent sections of 117 tissue margins which had been interpreted as negative on frozen section.
Mohs micrographic surgery appears to be an effective treatment for facial melanomas. Our study showed complete correlation between frozen section tissue margins and permanent section controls.
面部皮肤恶性黑色素瘤的治疗面临挑战，既要确保根除疾病，又要最大程度地保留组织。莫氏显微外科手术提供了一种通过组织学控制切除恶性黑色素瘤的方法。
本研究评估在单一机构中莫氏显微外科手术治疗面部黑色素瘤的疗效，并通过冰冻切片技术评估切缘控制的准确性。
在6年期间，对97例经活检证实为原位黑色素瘤或面部浸润性黑色素瘤的患者进行了莫氏显微外科手术治疗。在25例患者中，对冰冻切片时定义为黑色素瘤阴性的组织切缘，在福尔马林固定、石蜡包埋组织的永久切片组织学上进行重新评估。
97例患者中有92例获得随访信息（8 - 72个月；平均33个月）。无局部复发病例。92例患者中有89例存活且情况良好，无疾病证据。1例患者死于转移性黑色素瘤。在117个冰冻切片时被判定为阴性的组织切缘的永久切片上未发现原位或浸润性黑色素瘤。
莫氏显微外科手术似乎是治疗面部黑色素瘤的有效方法。我们的研究表明冰冻切片组织切缘与永久切片对照完全相符。
