Martin H M, Birkin A J, Theaker J M
Department of Histopathology, Southampton General Hospital, UK.
Histopathology. 1998 Apr;32(4):362-7. doi: 10.1046/j.1365-2559.1998.00379.x.
Wide local excision is commonly undertaken as part of the further management of cutaneous melanoma. Although the original excision is usually complete, pathologists vary considerably in their macroscopic handling and sampling of the wide excision specimens. This study evaluates the sampling of reexcision specimens and the information gained from histological examination of tissue blocks in order to develop guidelines for the handling of these specimens.
The study group comprises 219 cases of melanoma which underwent initial biopsy followed by wider excision. The macroscopic appearance, number of blocks taken and presence of residual melanoma in the wide excision specimen was assessed. Residual melanoma was detected in the wide excision specimen in only four cases out of the 167 in which the original melanoma had been described as completely excised and in these cases the detection of a residual lesion reflected either advanced local disease at the time of the original excision, or an incompletely excised extensive radial growth phase. The sampling of wide excision specimens varied (range of blocks 1-12, average 3.1) but statistical analysis showed no undersampling of the wide excision specimens in which no residual lesion was found.
These results show that detection of a residual lesion in wide excision specimens of melanomas previously completely excised is unusual and offers no additional clinically useful information. Random block taking in the absence of a macroscopic abnormality is therefore unlikely to be clinically useful. Guidelines for the gross handling of these wide excision specimens are proposed which are likely to save resources in most histopathology departments by reducing block numbers.
广泛局部切除通常作为皮肤黑色素瘤进一步治疗的一部分。尽管最初的切除通常是完整的，但病理学家对广泛切除标本的宏观处理和取材差异很大。本研究评估再次切除标本的取材以及从组织块组织学检查中获得的信息，以便制定这些标本处理的指南。
研究组包括219例黑色素瘤患者，这些患者先进行了初始活检，随后进行了更广泛的切除。评估了广泛切除标本的宏观外观、取材块数以及残留黑色素瘤的存在情况。在最初黑色素瘤被描述为完全切除的167例中，只有4例在广泛切除标本中检测到残留黑色素瘤，在这些病例中，残留病变的检测反映了最初切除时局部疾病进展，或者是广泛的放射状生长期切除不完全。广泛切除标本的取材各不相同（取材块数范围为1 - 12块，平均3.1块），但统计分析表明，在未发现残留病变的广泛切除标本中不存在取材不足的情况。
这些结果表明，在先前已完全切除的黑色素瘤广泛切除标本中检测到残留病变并不常见，且未提供额外的临床有用信息。因此，在没有宏观异常的情况下随机取材在临床上不太可能有用。本文提出了这些广泛切除标本大体处理的指南，通过减少取材块数，在大多数组织病理学科室可能会节省资源。
