Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden.
Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden, and; Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Pathology, Gothenburg, Sweden.
Acta Derm Venereol. 2024 Oct 3;104:adv40535. doi: 10.2340/actadv.v104.40535.
Standard treatment for lentigo maligna (LM) is surgical excision, yet insights into the frequency of and risk factors for incomplete excisions remain limited. The primary objectives were to assess the incomplete excision rate (IER) in primary LM and to explore potential risk factors for incomplete excisions. A retrospective analysis was conducted encompassing consecutive histopathologically confirmed LMs from 2014-2020. Descriptive statistics were used for LM characteristics and IER, while uni- and multivariate analyses were used for calculating risk factors. The study included 395 LMs with an IER of 16.7% (n = 66). Risk factors for higher incomplete excision rates included: head and neck lesions (p = 0.0014), clinical excision margins < 5 mm (p = 0.040), and utilization of preoperative partial biopsies (p = 0.023). Plastic surgeons had higher IERs than dermatologists (p = 0.036). Lesion diameter (p = 0.20) and surgeon experience (p = 0.20) showed no associations with incomplete excisions, yet LMs with a diameter ≥ 20 mm exhibited higher incomplete excision rates (23.2%) compared witho those < 10 mm (12.9%). LMs should be excised with at least 5-mm clinical margins, especially in the head and neck area. LMs ≥ 20 mm may be more surgically challenging. High-er incomplete excision rates associated with the use of preoperative biopsies and/or plastic surgeons may reflect challenging anatomical locations, larger lesion diameter, and/or ill-defined borders.
标准的治疗方法是手术切除，但对于不完全切除的频率和危险因素的了解仍然有限。主要目的是评估原发性黑素细胞痣（LM）的不完全切除率（IER），并探讨不完全切除的潜在危险因素。进行了一项回顾性分析，包括 2014 年至 2020 年连续的组织病理学证实的 LM。描述性统计用于 LM 特征和 IER，而单变量和多变量分析用于计算危险因素。该研究包括 395 例 LM，其中 IER 为 16.7%（n=66）。更高的不完全切除率的危险因素包括：头颈部病变（p=0.0014）、临床切除边缘<5mm（p=0.040）和术前部分活检的使用（p=0.023）。整形外科医生的 IER 高于皮肤科医生（p=0.036）。病变直径（p=0.20）和外科医生经验（p=0.20）与不完全切除无关，但直径≥20mm的 LM 与直径<10mm的 LM 相比，不完全切除率更高（23.2%）。LM 应至少切除 5mm 的临床边缘，特别是在头颈部区域。直径≥20mm 的 LM 可能更具手术挑战性。与术前活检和/或整形外科医生相关的较高不完全切除率可能反映了具有挑战性的解剖位置、更大的病变直径和/或定义不明确的边界。
