Crouch Gareth, Sinha Shiba, Lo Serigne, Saw Robyn P M, Lee Kenneth K, Stretch Jonathan, Shannon Kerwin, Guitera Pascale, Scolyer Richard A, Thompson John F, Ch'ng Sydney
Sydney Medical School, The University of Sydney, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
Department of Plastic and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
Eur J Surg Oncol. 2021 May;47(5):1145-1151. doi: 10.1016/j.ejso.2020.09.028. Epub 2020 Sep 23.
Lentigo maligna (LM), a subtype of melanoma in-situ commonly occurring in the head and neck region, often presents a treatment challenge due to anatomical constraints, particularly on the face of mostly elderly patients. This study sought to assess the clinical outcomes of wide local excision of head and neck LM, identify predictors of recurrence and define optimal excision margins.
Patients with LM treated between January 1997 and December 2012 were identified from the large institutional database of a tertiary center and their data were analyzed.
In 379 patients, 382 lesions were eligible for analysis. Median maximal lesion diameter was 10.5 mm. The mean surgical excision and histopathological clearance margins were 6.2 mm and 4.0 mm, respectively. Median follow-up was 32 months. The LM recurrence rate was 9.9%, and subsequent invasive melanoma developed in 2.3% of cases (mean Breslow thickness 0.7 mm). The recurrence rate was 27.2% if the histological margin was <3.0 mm (median time to recurrence 46.5 months) compared with 2.6% if the margin was ≥3.0 mm. The mean surgical margin required to achieve a histological clearance of ≥3.0 mm was 6.5 mm.
Our data suggest that to minimize recurrence, a histological margin of ≥3.0 mm is required. To achieve this, a surgical margin of ≥6.5 mm was required. This is greater than the 5 mm margin recommended in some national guidelines. Careful long-term follow-up is required for all patients because of the risk of recurrence.
恶性雀斑样痣（LM）是原位黑色素瘤的一种亚型，常见于头颈部区域，由于解剖学限制，尤其是在大多数老年患者的面部，常常带来治疗挑战。本研究旨在评估头颈部LM广泛局部切除的临床结果，确定复发的预测因素并定义最佳切除边缘。
从一家三级中心的大型机构数据库中识别出1997年1月至2012年12月期间接受治疗的LM患者，并对其数据进行分析。
379例患者中有382个病灶符合分析条件。病灶最大直径的中位数为10.5毫米。手术切除和组织病理学切缘的平均宽度分别为6.2毫米和4.0毫米。中位随访时间为32个月。LM复发率为9.9%，2.3%的病例随后发生侵袭性黑色素瘤（平均Breslow厚度0.7毫米）。如果组织学切缘<3.0毫米，复发率为27.2%（复发的中位时间为46.5个月），而切缘≥3.0毫米时复发率为2.6%。实现≥3.0毫米组织学切缘所需的平均手术切缘为6.5毫米。
我们的数据表明，为了将复发风险降至最低，需要≥3.0毫米的组织学切缘。要实现这一点，需要≥6.5毫米的手术切缘。这大于一些国家指南中推荐的5毫米切缘。由于存在复发风险，所有患者都需要进行仔细的长期随访。
