title: A method for distinguishing the intended margins for a melanoma from the tissue cones after surgical excision.
abstract: BACKGROUND
  Surgical excision of severely dysplastic nevi and thin cutaneous melanomas (<1 mm in depth) remains the most effective treatment to date. However, sometimes a severely dysplastic nevus may be upstaged to a melanoma in situ, or a melanoma in situ may be upgraded to an invasive melanoma once the completely excised specimen is reviewed microscopically. This then requires a re-excision around the entire scar at follow-up as the dermatological surgeon can be perplexed as to where the precise locations of the pigmented lesion and the tissue cones are, thereby generating a longer scar.
  
  
  OBJECTIVE
  We want to introduce a simple, cost-effective and easy-to-implement approach that permits the dermatological surgeon to distinguish from a linear scar the site of the original pigmented lesion and the lengths of the tissue cones. Therefore, if a re-excision is necessary, instead of surgical removal around the entire scar, only a focal directed excision of the pigmented lesion is necessary and this will result in a shorter scar; this will be useful for cosmetically sensitive areas on the face. A case is included to illustrate our objective.
  
  
  CONCLUSIONS
  Using our surgical method on a patient's left cheek pigmented lesion originally diagnosed as melanoma in situ with a subsequent revised diagnosis of invasive melanoma generated a shorter scar and a favorable cosmetic outcome.
authors.affiliation: Department of Dermatology, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Kriegel
authors.forename: Ellen
authors.initials: E
authors.lastname: Marmur
authors.forename: Hui Yi
authors.initials: HY
authors.lastname: Shan
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Mercer
authors.forename: Miriam B
authors.initials: MB
authors.lastname: Birge
authors.forename: Arnold
authors.initials: A
authors.lastname: Lee
mesh_terms: D002921:Cicatrix / Q000473:pathology*; D019092:Conization / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009508:Nevus, Pigmented / Q000473:pathology* / Q000601:surgery*; D012086:Reoperation; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*