Garcia Daniel, Eilers Robert E, Jiang S Brian
Department of Dermatology, Dermatologic and Mohs Micrographic Surgery Center, San Diego School of Medicine, University of California.
J Clin Investig Dermatol. 2017 Feb;5(1). doi: 10.13188/2373-1044.1000037. Epub 2017 Feb 27.
Cutaneous melanoma is one of the fastest rising cancer diagnoses in recent years. Melanoma in situ (MIS) constitutes a large proportion of all diagnosed melanomas. While surgical excision is considered the standard of therapy, the literature is not clear on which surgical technique minimizes local recurrence. A common technique is serial staged excision (SSE), in which a series of mapped excisions are made according to histopathological examination of tissue. Previously published recurrence rates for SSE ranges from 0-12%, over a range of 4.7-97 months of mean follow-up.
To investigate the recurrence rate of MIS when excised using a serial disk staged excision technique with tissue marked at 12 O'clock for mapping, rush permanent processing and histologic examination, 3-suture tagging for subsequent stages, and "breadloafing" microscopic analysis. Additionally, to determine the relationship between initial lesion size and subsequent stages of excision required for clearance, and final surgical margin.
Single-institution retrospective chart review of 29 biopsy confirmed MIS lesions treated with our variant of SSE. Statistical analysis via independent t-tests.
No recurrences were observed with mean follow-up of 31.5 months (SD 13.9), over range of 12-58 months. Mean surgical margin of 13.1 mm (SD 5.9). A trend towards larger surgical margin was seen with increasing pre-operative lesion size.
This method of SSE for treatment of MIS is comparable in efficacy to other SSE techniques, and may offer physicians a relatively simple, efficacious, and accessible alternative to wide local excision and Mohs micrographic surgery.
皮肤黑色素瘤是近年来癌症诊断中增长最快的疾病之一。原位黑色素瘤（MIS）在所有诊断出的黑色素瘤中占很大比例。虽然手术切除被认为是治疗的标准方法，但关于哪种手术技术能使局部复发率降至最低，文献中尚无明确结论。一种常用的技术是分期连续切除（SSE），即根据组织的组织病理学检查进行一系列标记切除。先前发表的SSE复发率在0%至12%之间，平均随访时间为4.7至97个月。
研究采用分期连续盘状切除技术治疗MIS的复发率，该技术包括在12点位置标记组织以进行定位、快速永久制片和组织学检查、用3针缝线标记以便后续操作，以及“面包片”式显微镜分析。此外，确定初始病变大小与清除所需的后续切除阶段以及最终手术切缘之间的关系。
对29例经活检证实为MIS且采用我们改良的SSE方法治疗的病变进行单机构回顾性病历审查。通过独立t检验进行统计分析。
平均随访31.5个月（标准差13.9），随访时间为12至58个月，未观察到复发。平均手术切缘为13.1毫米（标准差5.9）。随着术前病变大小的增加，手术切缘有增大的趋势。
这种治疗MIS的SSE方法在疗效上与其他SSE技术相当，可能为医生提供一种相对简单、有效且可行的替代广泛局部切除和莫氏显微外科手术的方法。
