Department of Internal Medicine, Albany Medical Center, Albany, New York.
Dermatol Surg. 2013 Mar;39(3 Pt 1):365-71. doi: 10.1111/dsu.12078. Epub 2013 Jan 28.
Recent Recovery Audit Contractor audits have targeted Mohs micrographic surgery (MMS) if permanent-section pathology codes have been used on the same day. In lentigo maligna (LM) or melanoma in situ (MIS) cases, this is done to further evaluate the tumor for staging.
To determine the percentage of LM, MIS, and thin invasive melanomas upstaged when a central debulking specimen from MMS is sent for permanent vertical sections.
A single-center retrospective study examining LM, MIS, and thin melanomas treated with MMS between January 1, 2004, and September 30, 2011, at Vanderbilt University was performed. The elements needed for staging, sex, age, tumor location, size, and previous skin cancer history were obtained.
Fourteen of 173 cases (8.1%; 95% confidence interval = 4.9-13.1%) were identified in which the tumor was upstaged; 13 of the cases initially diagnosed as LM or MIS were invasive (average Breslow depth 0.69 mm). One melanoma at 0.6 mm depth on initial biopsy increased to 1.2 mm after the debulking specimen from Mohs surgery was examined histologically. Debulking in four cases revealed a depth of 1 mm or greater. No differences existed in characteristics between upstaged and nonupstaged cases.
When performing MMS for LM or MIS, it is appropriate and necessary to send the central debulking specimen for permanent histology for accurate tumor staging.
最近的康复审核承包商审计针对 Mohs 显微外科手术（MMS）进行了审计，如果在同一天使用了永久性切片病理学代码。在恶性雀斑样痣（LM）或原位黑色素瘤（MIS）病例中，这是为了进一步评估肿瘤的分期。
确定当从 MMS 切除的中央组织块被送作永久性垂直切片时，LM、MIS 和薄侵袭性黑色素瘤被升级分期的百分比。
对 2004 年 1 月 1 日至 2011 年 9 月 30 日期间在范德比尔特大学接受 MMS 治疗的 LM、MIS 和薄黑色素瘤进行了单中心回顾性研究。获得了分期所需的要素，包括性别、年龄、肿瘤位置、大小和既往皮肤癌病史。
在 173 例病例中，有 14 例（8.1%；95%置信区间 4.9-13.1%）被确定为肿瘤升级；最初诊断为 LM 或 MIS 的 13 例为侵袭性（平均 Breslow 深度为 0.69 毫米）。一例最初活检深度为 0.6 毫米的黑色素瘤，在Mohs 手术切除的中央组织块进行组织学检查后增加到 1.2 毫米。在 4 例病例中，切除组织块的深度为 1 毫米或更深。升级和未升级病例的特征之间没有差异。
当对 LM 或 MIS 进行 MMS 时，为了准确分期肿瘤，适当且有必要将中央切除组织块送作永久性组织学检查。
