title: Frequency of residual melanoma in wide local excision (WLE) specimens after complete excisional biopsy.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Breast, Endocrine, and General Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia; General Surgery, Alfred Hospital, Melbourne, Australia. Electronic address: bolshinskyv@gmail.com.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Bolshinsky
authors.affiliation: Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Lin
authors.affiliation: General Surgery, Alfred Hospital, Melbourne, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Serpell
authors.affiliation: Plastics, Hand, Facio-Maxillary Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Leung
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Rory
authors.initials: R
authors.lastname: Wolfe
authors.affiliation: Department of Anatomical Pathology, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Catriona
authors.initials: C
authors.lastname: McLean
authors.affiliation: Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: John W
authors.initials: JW
authors.lastname: Kelly
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001315:Australia; D001706:Biopsy / Q000379:methods*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: complete excisional biopsy; cutaneous melanoma; lentigo maligna; lentigo maligna melanoma; nodular melanoma; residual disease; residual melanoma; superficial spreading melanoma; wide local excision