Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Am Acad Dermatol. 2018 Dec;79(6):1109-1116.e1. doi: 10.1016/j.jaad.2018.06.058. Epub 2018 Jul 10.
The efficacy of Mohs micrographic surgery (MMS) for atypical intraepidermal melanocytic proliferation (AIMP) is unknown.
To ascertain the frequency of diagnostic change to melanoma (upstaging) and the frequency of local recurrence after MMS for AIMP. A secondary outcome was the frequency of subclinical spread (defined as the requirement for >1 stage of MMS to achieve tumor-free margins).
Retrospective, cross-sectional study of 223 AIMP (with 92.4% located on the head, neck, hand, foot, or pretibial leg) patients treated with MMS with melanoma antigen recognized by T cells 1 (MART-1) immunostaining.
Upstaging to unequivocal melanoma in situ or invasive melanoma was identified in 18.8% (42/223) of all AIMP patients. The local recurrence rate was 0% (0/223) with a mean follow-up time of 2.7 years (998 days). Subclinical spread was present in 23.8% (53/223) of AIMP patients.
Single site, retrospective design, observational study, lack of objective criteria to diagnose AIMP.
MMS with MART-1 immunostaining achieves excellent local control of specialty site AIMP and permits definitive removal of subclinical spread before reconstruction. The central debulking excision should be evaluated with formalin-fixed paraffin-embedded section staining, since a significant percentage of AIMP are reclassified as melanoma in situ or invasive melanoma.
Mohs 显微外科手术（MMS）治疗非典型表皮内黑色素细胞增殖（AIMP）的疗效尚不清楚。
确定 MMS 治疗 AIMP 后诊断性改变为黑色素瘤（升级）的频率和局部复发的频率。次要结果是确定临床前扩散的频率（定义为需要 >1 次 MMS 以获得肿瘤无残留边缘）。
回顾性、横断面研究 223 例接受 MMS 治疗的 AIMP（92.4%位于头、颈、手、脚或小腿前）患者，采用黑色素瘤抗原识别 T 细胞 1（MART-1）免疫染色。
所有 AIMP 患者中有 18.8%（42/223）升级为明确的原位黑色素瘤或侵袭性黑色素瘤。局部复发率为 0%（0/223），平均随访时间为 2.7 年（998 天）。23.8%（53/223）的 AIMP 患者存在临床前扩散。
单部位、回顾性设计、观察性研究，缺乏诊断 AIMP 的客观标准。
MMS 联合 MART-1 免疫染色可实现对特殊部位 AIMP 的优异局部控制，并允许在重建前明确切除临床前扩散。中央切块切除应通过福尔马林固定石蜡包埋切片染色进行评估，因为 AIMP 的很大一部分被重新分类为原位黑色素瘤或侵袭性黑色素瘤。
