Campbell Elliott H, Crum Olivia M, Chelf Cynthia J, Demer Addison M, Brewer Jerry D
Department of Dermatology, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota.
Mayo Clinic College of Medicine and Science, Library-Public Services, Mayo Clinic, Rochester, Minnesota.
Dermatol Surg. 2023 Feb 1;49(2):119-123. doi: 10.1097/DSS.0000000000003683. Epub 2023 Jan 19.
Current consensus guidelines have discouraged the use of sub-0.5-cm (in situ) and sub-1-cm (invasive) margins when performing Mohs micrographic surgery (Mohs) for melanoma, with minimal evidence to guide this recommendation.
To compare melanoma local recurrence rates after Mohs based on initial margin size.
A systematic review and meta-analysis was conducted with search terms including Mohs micrographic surgery, surgical margin, recurrent disease, and melanoma.
Forty-three studies were included. The 5- to 10-mm margin category had a statistically significant lower local recurrence compared with 1- to 5-mm and 5-mm categories. Recurrence for 1- to 5-mm, 5-mm, 5- to 10-mm, and 10-mm categories were 2.3% (CI 0.8-3.5, p < .001), 1.4% (CI 0.6-2.2, p < .001), 0.3% (CI 0.2-0.5, p < .001), and 6.1% (CI -6.7 - 18.8, p = .349), respectively. Number of stages for 1 to 5, 5, 5 to 10, and 10-mm categories were 1.8, 1.8, 1.6, and 1.6, respectively. There was no statistically significant difference between the groups (p = .694).
Five- to 10-mm margins were associated with the lowest local recurrence rates. A 5- to 10-mm initial margin should be considered where other factors (tumor characteristics, anatomical or functional considerations) allow.
目前的共识指南不鼓励在对黑色素瘤进行莫氏显微外科手术（Mohs）时使用小于0.5厘米（原位）和小于1厘米（浸润性）的切缘，支持这一建议的证据很少。
比较基于初始切缘大小的Mohs术后黑色素瘤局部复发率。
进行了一项系统评价和荟萃分析，检索词包括莫氏显微外科手术、手术切缘、复发性疾病和黑色素瘤。
纳入43项研究。与1至5毫米及5毫米切缘组相比，5至10毫米切缘组的局部复发率在统计学上显著更低。1至5毫米、5毫米、5至10毫米和10毫米切缘组的复发率分别为2.3%（95%CI 0.8 - 3.5，p <.001）、1.4%（95%CI 0.6 - 2.2，p <.001）、0.3%（95%CI 0.2 - 0.5, p <.001）和6.1%（95%CI -6.7 - 18.8, p =.349）。1至5毫米、5毫米、5至10毫米和10毫米切缘组的分期数分别为1.8、1.8、1.6和1.6。各组之间无统计学显著差异（p =.694）。
5至10毫米切缘与最低的局部复发率相关。在其他因素（肿瘤特征、解剖或功能考虑）允许的情况下，应考虑初始切缘为5至10毫米。
