Moura Francisco S, Homer Lucy E, McKirdy Stuart W
Department of Plastic & Reconstructive Surgery, Royal Preston Hospital, PR29HT, Fulwood, UK.
J Skin Cancer. 2020 Oct 29;2020:8813050. doi: 10.1155/2020/8813050. eCollection 2020.
The incidence of melanoma in situ (MIS) is increasing faster compared to invasive melanoma. Despite varying international practice, a minimum of 5 mm surgical excision margin is currently recommended in the UK. There is no clear guidance on the minimum histological peripheral clearance margins.
This study compares the histological peripheral clearance margins of MIS using wide local excision (WLE) to the rate of recurrence and progression to invasive disease.
A retrospective single-center review was performed over a 5-year period. Inclusion criteria consisted of MIS diagnosis, ≥16 years of age, and treatment with WLE with curative intent. Those patients with a recurrence of a previous MIS or with a reported focus of invasion/regression were also included. Clinicopathological data and follow-up were recorded.
167 MIS were identified in 155 patients, 80% of which were lentigo maligna subtype. Of patients with completely excised MIS on histology (>0 mm), 9% had recurrence with a median time to recurrence of 36 months. Three (1.8%) cases recurred as invasive disease. Age, MIS site, MIS subtype, and histological evidence of foci of invasion/regression did not predict recurrence nor progression to invasive disease ( > 0.05). The recurrence rate of MIS with a histological excision margin ≤3.0 mm was 13% compared to 3% in those with histology margins of >3.0 mm (=0.049).
A histological peripheral clearance of at least 3.0 mm is advocated to achieve lower recurrence rates. The follow-up duration should be reviewed due to the median recurrence occurring at 36 months in our cohort. Cumulative work on MIS needs to be collated and completed in a large multicenter study with a long follow-up period.
原位黑色素瘤（MIS）的发病率相比侵袭性黑色素瘤增长更快。尽管国际上的做法各异，但目前英国建议手术切缘至少为5毫米。对于最小组织学边缘清除切缘尚无明确指导。
本研究比较采用广泛局部切除（WLE）的原位黑色素瘤的组织学边缘清除切缘与复发率以及进展为侵袭性疾病的发生率。
进行了一项为期5年的回顾性单中心研究。纳入标准包括原位黑色素瘤诊断、年龄≥16岁以及采用根治性目的的广泛局部切除治疗。既往原位黑色素瘤复发或有侵袭/消退病灶报告的患者也纳入研究。记录临床病理数据和随访情况。
在155例患者中识别出167例原位黑色素瘤，其中80%为恶性雀斑样痣亚型。组织学上原位黑色素瘤完全切除（>0毫米）的患者中，9%复发，复发的中位时间为36个月。3例（1.8%）复发为侵袭性疾病。年龄、原位黑色素瘤部位、原位黑色素瘤亚型以及侵袭/消退病灶的组织学证据均不能预测复发或进展为侵袭性疾病（P>0.05）。组织学切除切缘≤3.0毫米的原位黑色素瘤复发率为13%，而切缘>3.0毫米的患者复发率为3%（P=0.049）。
主张至少3.0毫米的组织学边缘清除以实现较低的复发率。鉴于我们队列中复发中位时间为36个月，应重新审视随访时长。原位黑色素瘤的累积研究工作需要在一项长期随访的大型多中心研究中进行整理和完善。
