title: Predicting positive margins in resection of cutaneous melanoma of the head and neck.
abstract: OBJECTIVE
  Head and neck melanoma surgeons must achieve negative margins before performing margin compromising reconstructions such as a local flap closure. This often necessitates staged operations, including further margin resection. Peripheral sampling is often used before definitive resection to help guide the extent of the resection. If melanoma margin status could be predicted based on lesion characteristics, the surgeon could be more confident in performing definitive closure immediately after resection of some lesions or confident in the need to take larger margins in predictably extensive lesions.
  
  
  METHODS
  Retrospective review and logistic regression analysis.
  
  
  METHODS
  Institutional review board approval was obtained. Out of 637 patients treated for head and neck melanoma by the Department of Otolaryngology-Head and Neck Surgery in the last 10 years, 409 patients had primary resection with available histopathologic margin status used as the outcome variable. Predictor variables of demographics, lesion size, pathologic subtype, location on face, and depth of invasion were collected.
  
  
  RESULTS
  Histopathologic margin status could be predicted by age but not by the other predictor variables.
  
  
  CONCLUSIONS
  In this large series of head and neck melanomas excised using National Comprehensive Cancer Network-recommended margins, histopathologic margin status could be predicted based on age but not on lesion characteristics. This finding is surprising given the published data showing that melanoma in situ has a higher rate of positive margin compared to subtypes of invasive melanoma. It reinforces the need for delaying reconstruction until margins are clear or performing reconstruction at a time of resection that does not compromise the ability to resect margins further (e.g., skin graft).
authors: Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA. jjc3y@virginia.edu
authors: J Jared
authors: JJ
authors: Christophel
authors: Andrew K
authors: AK
authors: Johnson
authors: Timothy L
authors: TL
authors: McMurry
authors: Stephen S
authors: SS
authors: Park
authors: Paul A
authors: PA
authors: Levine
mesh_terms: D000328:Adult; D000368:Aged; D005153:Facial Neoplasms / Q000473:pathology; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D016015:Logistic Models; D008545:Melanoma / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D012372:ROC Curve; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*