Skin mapping with punch biopsies for defining margins in melanoma: when you don't know how far to go.
BACKGROUND
Wide local excision of primary cutaneous melanoma usually provides clear margins and excellent local control. Nonclassical presentations of cutaneous melanoma, however, can challenge this treatment algorithm. Specifically, persistent melanoma-in-situ (MIS) at the margin not suspected clinically makes planning definitive wide local excision more difficult. We hypothesized that the use of punch biopsies as a mapping tool would allow us to obtain clear margins in these challenging cases.


METHODS
Punch biopsies were performed at sites 1 to 2 cm from prior positive margins. Subsequent wide local excision was planned, including all punch biopsy sites with positive findings: atypical melanocytic hyperplasia, MIS, or invasive melanoma. The management of three patients was documented prospectively. Standard surgical techniques were used independent of an experimental protocol. Medical records were reviewed, and data were summarized under institutional review board protocol HIC 10803.


RESULTS
The results of punch biopsies identified invasive melanoma, MIS, or atypical melanocytic hyperplasia in all three patients with MIS at the margins. All three mapping procedures were well tolerated and resulted in resection with negative margins in a single definitive resection.


CONCLUSIONS
Melanoma mapping with punch biopsy technique allows for definitive excision in cases when disease persists at the margins of the reexcision or in cases with unclear clinical examinations.
Dengel
Lynn
L
Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA.
Turza
Kristin
K
Noland
Mary-Margaret B
MM
Patterson
James W
JW
Slingluff
Craig L
CL
D000328:Adult; D000368:Aged; D001706:Biopsy; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012878:Skin Neoplasms / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D016038:Skin Transplantation
Dermatol Surg. 1998 Oct;24(10):1105-10
9793522
Ann Plast Surg. 2001 May;46(5):495-9; discussion 499-500
11352422
J Surg Oncol. 2005 Aug 1;91(2):120-5
16028282
J Clin Oncol. 2002 Apr 1;20(7):1818-25
11919239
Ann Surg. 1984 Dec;200(6):759-63
6508406
Dermatol Surg. 2008 May;34(5):660-4
18261099
Dermatol Clin. 1989 Oct;7(4):833-43
2676291
Lancet. 2002 Sep 14;360(9336):878
12243953
Br J Dermatol. 2002 Feb;146(2):290-4
11903242
Australas J Dermatol. 1999 Feb;40(1):25-30
10098285
J Am Acad Dermatol. 2008 Jan;58(1):142-8
18029055
J Clin Oncol. 2001 May 1;19(9):2370-80
11331315
J Clin Oncol. 1996 Jan;14(1):7-17
8558223
J Dermatol Surg Oncol. 1979 Sep;5(9):727-37
489814
J Am Acad Dermatol. 1997 Nov;37(5 Pt 1):758-64
9366823
Br J Dermatol. 1999 Feb;140(2):249-54
10233217
Arch Dermatol. 2004 Sep;140(9):1087-92
15381549
Int J Dermatol. 2005 May;44(5):428-34
15869545
Br J Dermatol. 2005 Nov;153(5):1031-6
16225620
Cancer. 2004 Mar 15;100(6):1293-301
15022299
Br J Dermatol. 2008 Feb;158(2):329-33
18215250
Dermatol Surg. 2002 Aug;28(8):656-65
12174054
Clin Cancer Res. 2004 Mar 1;10(5):1670-7
15014018
Dermatol Surg. 2007 Feb;33(2):199-207
17300606