Staged excision versus Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma - 19/08/11
, Richard K. Scupham, MD, PhD b, Andrew K. Bean, MD a, Roger I. Ceilley, MD a
Reprint requests: Hobart W. Walling, MD, PhD, 6000 University Ave, West Des Moines, IA 50266.Abstract |
Background |
Lentigo maligna (LM) is a relatively common tumor with increasing prevalence and substantial morbidity. A variety of treatment modalities are available, though margin-control surgery offers the highest cure rate. We were interested in comparing long-term outcomes of Mohs micrographic surgery (MMS) versus staged excision with permanent sections (SE) for treating LM or LM melanoma (LMM).
Methods |
Comparative study consisting of retrospective chart review from our private practice.
Results |
Fifty-seven patients (31 male, 26 female, mean age at diagnosis 69.1 ± 10.1 years) were treated in our office for LM (50) or LMM (9) between January 1986 and December 2001. Forty-one tumors (71%) were located on the head and neck. Fifty-three of the 59 tumors (90%) were primary, and 6/59 (10%) were recurrent at the time of initial treatment. Forty-one tumors (36 LM, 5 LMM) were treated with SE, and 18 (14 LM, 4 LMM) were treated with MMS. The mean preoperative lesion size (1.5 ± 0.2 cm2 for SE; 1.2 ± 0.4 cm2 for MMS), mean postoperative defect size (7.1 ± 1 cm2 for SE; 7.1 ± 1.4 cm2 for MMS), and the ratio of postoperative defect to preoperative lesion size (7.9-fold increase for SE, 11.2-fold increase for MMS) were similar between the cohorts. Mean number of stages for clear margins were similar, with 1.8 ± 0.2 stages (range: 1-7) for SE and 2.0 ± 0.2 stages (range: 1-4) for MMS; clear margins were obtained in one or two stages in 85% of cases for SE and in 67% for MMS. Three recurrences (3/41; 7.3%) occurred in the SE group while 6 recurrences (6/18; 33%) occurred in the MMS group (P < .025). The mean follow-up duration was 95 months (range: 60-240) in the SE group and 117.5 months (range: 61-157) in the MMS group.
Limitations |
Results are limited to a single practice site and fewer patients underwent MMS compared to SE. Patients were not randomized as cases were ascertained retrospectively.
Conclusion |
Staged excision of LM and LMM is associated with a significantly lower recurrence rate with no difference in surgical defect size compared to MMS. To our knowledge, this is the first study directly comparing these two surgical techniques for managing this form of melanoma. Our extended follow-up duration exceeds that of most previous reports.
Le texte complet de cet article est disponible en PDF.Plan
| Funding sources: None. |
|
| Conflicts of interest: None declared. |
|
| Presented at the American College of Mohs Micrographic Surgery and Cutaneous Oncology 38th annual meeting, Scottsdale, AZ, April 28-30, 2006. |
Vol 57 - N° 4
P. 659-664 - octobre 2007 Retour au numéro
Article précédent
- In vivo reflectance confocal microscopy imaging of melanocytic skin lesions: Consensus terminology glossary and illustrative images
- Alon Scope, Cristiane Benvenuto-Andrade, Anna-Liza C. Agero, Josep Malvehy, Susana Puig, Milind Rajadhyaksha, Klaus J. Busam, Diego E. Marra, Abel Torres, Iva Propperova, Richard G. Langley, Ashfaq A. Marghoob, Giovanni Pellacani, Stefania Seidenari, Allan C. Halpern, Salvador Gonzalez
- Giant verrucous porokeratosis of Mibelli mimicking psoriasis in a patient with psoriasis
- Clara De Simone, Andrea Paradisi, Guido Massi, Ilaria Proietti, Angela Capponi, Pier Luigi Amerio, Rodolfo Capizzi
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?