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Journal of the American Academy of Dermatology
Volume 74, n° 1
pages 102-107 (janvier 2016)
Doi : 10.1016/j.jaad.2015.08.065
accepted : 31 August 2015
Original Articles

Frequency of residual melanoma in wide local excision (WLE) specimens after complete excisional biopsy
 

Vladimir Bolshinsky, MBBS, DipSurgAnat, FRACS a, b, , Matthew J. Lin, MBBS (Hons), BMedSc c, Jonathan Serpell, MBBS, MD, MEd, FRACS, FACS b, Michael Leung, MBBS, FRACS d, Rory Wolfe, BSc, PhD f, Catriona McLean, MD, FRCPA e, John W. Kelly, MD, FACD c
a Breast, Endocrine, and General Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia 
b General Surgery, Alfred Hospital, Melbourne, Australia 
c Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia 
d Plastics, Hand, Facio-Maxillary Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia 
e Department of Anatomical Pathology, Alfred Hospital, Melbourne, Victoria, Australia 
f Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia 

Reprint requests: Vladimir Bolshinsky, MBBS, DipSurgAnat, FRACS, Breast, Endocrine, and General Surgery Unit, General Surgery, Alfred Hospital, PO Box 315, Prahran, Victoria 3181, Australia.
Abstract
Objective

We sought to better understand the role of wide local excision (WLE) in the treatment of cutaneous melanoma by analyzing residual or locally metastatic disease in WLE specimens of melanomas initially diagnosed with a complete excisional biopsy.

Methods

This was a retrospective review of 807 consecutive WLEs of melanomas diagnosed after complete excisional biopsy. All specimens were reviewed by a single dermatopathologist. Risk of residual or locally metastatic disease was analyzed using univariate and multivariate logistic regression models.

Results

In the 807 WLE specimens, further melanoma was found in 34 cases (4.2%; 95% confidence interval [CI] 2.9-5.8). Residual primary melanoma was found in 33 of these. On univariate analysis, features associated with residual or locally metastatic disease were histologic subtype (odds ratio 3.0; 95% CI 1.3-7.1, P  = .01) and tumor location (odds ratio 7.3; 95% CI 2.0-26.6, P  < .01). On multivariate analysis, lentigo maligna was independently associated with melanoma remaining in WLE specimens (odds ratio 2.7; 95% CI 1.0-7.3, P  = .04).

Conclusion

Residual melanoma in WLE specimens after histologically assessed complete excisional biopsy is not uncommon. Patients with lentigo maligna subtype melanomas are most at risk. Our findings indicate that the procedure of WLE is most important therapeutically for its role in controlling the primary tumor, rather than in preventing local metastatic recurrence.

The full text of this article is available in PDF format.

Key words : complete excisional biopsy, cutaneous melanoma, lentigo maligna, lentigo maligna melanoma, nodular melanoma, residual disease, residual melanoma, superficial spreading melanoma, wide local excision

Abbreviations used : CI, IQR, LM, LMM, OR, SSM, WLE



 Funding sources: None.
 Conflicts of interest: None declared.



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