Navarrete-Dechent C, Aleissa S, Cordova M, Liopyris K, Lee E H, Rossi A M, Hollman T, Pulitzer M, Lezcano C, Busam K J, Marghoob A A, Chen C-C J, Nehal K S
Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
J Eur Acad Dermatol Venereol. 2020 Oct;34(10):2280-2287. doi: 10.1111/jdv.16272. Epub 2020 Mar 15.
Lentigo maligna/lentigo maligna melanoma (LM/LMM) poses a treatment and surgical challenge given unpredictable subclinical extension resulting in incomplete excision.
To describe the demographic, clinical and pathologic characteristics of incompletely excised LM/LMM. To evaluate the potential role of reflectance confocal microscopy (RCM).
A retrospective review of a melanoma database at a tertiary cancer centre for patients referred with 'incompletely excised LM/LMM' or 'incompletely excised melanoma' between October 2006 and July 2017. We recorded clinical and pathological data and surgical margins needed to clear the residual LM/LMM. The second part consisted of a prospective cohort of patients in which RCM was performed when presenting with incompletely excised LM/LMM.
We included a total of 67 patients (retrospective + prospective cohort); mean age was 64.9 (standard deviation: 11.3) years and 52.2% were males. For the retrospective cohort (n = 53), the mean scar size was 3.4 cm. The average initial margins excised prior to presentation were 4.8 mm (range 3-7 mm). The average additional margin needed to clear the residual, incompletely excised LM/LMM was 7.8 mm. For the prospective cohort (n = 14), there were no differences in age, gender or size when compared to the retrospective cohort. RCM had a diagnostic accuracy of 78.6%, a sensitivity of 90.9%, a specificity of 33.3% and a positive predictive value of 83.3% for the detection of incompletely excised LM/LMM.
Incompletely excised LM/LMM is a poorly characterized clinical-pathological scenario that may require considerable extra margins for microscopic clearance. RCM may emerge as a valuable tool for the evaluation of patients with incompletely excised LM/LMM.
恶性雀斑样痣/恶性雀斑样痣黑色素瘤（LM/LMM）因亚临床扩展难以预测，导致切除不彻底，给治疗和手术带来挑战。
描述切除不彻底的LM/LMM的人口统计学、临床和病理特征。评估反射式共聚焦显微镜（RCM）的潜在作用。
对一家三级癌症中心黑色素瘤数据库进行回顾性研究，纳入2006年10月至2017年7月期间因“LM/LMM切除不彻底”或“黑色素瘤切除不彻底”前来就诊的患者。我们记录了临床和病理数据以及清除残留LM/LMM所需的手术切缘。第二部分为前瞻性队列研究，针对切除不彻底的LM/LMM患者进行RCM检查。
我们共纳入67例患者（回顾性研究+前瞻性队列）；平均年龄为64.9岁（标准差：11.3），男性占52.2%。回顾性队列（n = 53）中，平均瘢痕大小为3.4 cm。就诊前切除的初始平均切缘为4.8 mm（范围3 - 7 mm）。清除残留的、切除不彻底的LM/LMM所需的平均额外切缘为7.8 mm。前瞻性队列（n = 14）与回顾性队列相比，年龄？性别或大小无差异。RCM检测切除不彻底的LM/LMM的诊断准确率为78.6%，灵敏度为90.9%，特异度为33.3%，阳性预测值为83.3%。
切除不彻底的LM/LMM是一种临床病理特征尚不明确的情况，可能需要相当宽的额外切缘以实现显微镜下清除。RCM可能成为评估切除不彻底的LM/LMM患者的有价值工具。 （注：原文中“年龄？性别或大小无差异”处“年龄？”表述有误，可能是遗漏了比较词，如“年龄、性别或大小无差异”，但按要求未添加解释，直接翻译）
