title: Treatment of Head and Neck Melanoma In Situ With Staged Contoured Marginal Excisions.
abstract: Staged marginal evaluation of melanoma in situ (MIS) is performed to avoid reconstruction on positive margins. Contoured marginal excision (CME) is an excision of a 2-mm wide strip of normal-appearing skin taken approximately 5 mm from the visible tumor periphery. If positive, a new CME is excised; the tumor is resected once negative margins are confirmed. The purpose of this study is to report our experience using this technique for the treatment of head/neck MIS. Clinicopathological data were abstracted for all patients who underwent staged CME followed by central tumor resection for head/neck MIS; patients with invasive melanoma were excluded. Statistical analyses included χ test and t test. Overall, 127 patients with MIS were identified. Fifty-six percent were men; the average age was 68 years. The median number of CME procedures per patient was 1 (range, 1-4). Twenty-three percent of patients required more than 1 CME procedure to achieve negative margins. Local recurrence occurred in 3 of 127 patients after a median follow-up of 5 months. Patients requiring multiple CME procedures were more likely to experience local recurrence (P < 0.001). In conclusion, this technique is an effective method to avoid reconstruction on positive MIS margins with high local disease control rates.
authors.affiliation: From the *Department of Cutaneous Oncology, Moffitt Cancer Center; †Department of Oncologic Sciences, University of South Florida Morsani College of Medicine; ‡Department of Anatomic Pathology, Moffitt Cancer Center, and Departments of Pathology & Cell Biology, and Dermatology, and §Division of Plastic Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Glazer
authors.forename: Caitlin F
authors.initials: CF
authors.lastname: Porubsky
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Francis
authors.forename: Jamie
authors.initials: J
authors.lastname: Ibanez
authors.forename: Nicholas
authors.initials: N
authors.lastname: Castner
authors.forename: Jane L
authors.initials: JL
authors.lastname: Messina
authors.forename: Amod A
authors.initials: AA
authors.lastname: Sarnaik
authors.forename: Michael A
authors.initials: MA
authors.lastname: Harrington
authors.forename: C Wayne
authors.initials: CW
authors.lastname: Cruse
authors.forename: Vernon K
authors.initials: VK
authors.lastname: Sondak
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Zager
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome