title: Efficacy of Staged Excision With Permanent Section Margin Control for Cutaneous Head and Neck Melanoma.
abstract: Melanoma arising in chronically photodamaged skin, especially on the head and neck, is often characterized by poorly defined clinical margins and unpredictable occult extension. Staged excision techniques have been described to treat these challenging melanomas.
  
  
  
  To investigate the local recurrence rates and margin to clearance end points using staged excision with comprehensive hematoxylin-eosin-stained permanent section margin control.
  
  
  
  In this observational cohort study performed from October 8, 1997, to December 31, 2006, with a median follow-up of 9.3 years, 806 patients with melanoma on the head and neck, where clinical occult extension is common, were studied at an academic medical center.
  
  
  
  Staged excision with comprehensive hematoxylin-eosin-stained permanent section margin control commonly known as the square technique.
  
  
  
  Local recurrence rates and margin to clearance end points.
  
  
  
  A total of 806 patients (276 women [34.2%]; 805 white [99.9%]) with a median age at the time of first staged excision procedure of 65 years (range, 20-94 years) participated in the study. The estimated local recurrence rates were 1.4% at 5 years, 1.8% at 7.5 years, and 2.2% at 10 years. For each 50-mm2 increase in the size of the clinical lesion, there was a 9% increase in the rate of local recurrence (hazard ratio, 1.09; 95% CI, 1.02-1.15; P = .02). The mean (SD) margin from lesion to clearance for melanoma in situ was 9.3 (5.1) mm compared with 13.7 (5.9) mm for invasive melanoma. For melanoma in situ, margins were clear after 5 mm or less in 232 excisions (41.1%) and after 10 mm or less in 420 excisions (74.5%). For invasive melanoma, margins were clear after 5 mm or less in 8 excisions (3.0%) and after 10 mm or less in 141 excisions (52.2%).
  
  
  
  Staged excision with comprehensive permanent section margin control of melanomas arising in chronically sun-damaged skin on the head and neck has favorable recurrence rates when melanoma margins are difficult to assess, and recurrence rates are high with traditional techniques.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Moyer
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor.
authors.forename: Shannon
authors.initials: S
authors.lastname: Rudy
authors.affiliation: Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Boonstra
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor.
authors.forename: Casey
authors.initials: C
authors.lastname: Kraft
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Chinn
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor.
authors.forename: Shan R
authors.initials: SR
authors.lastname: Baker
authors.affiliation: Department of Dermatology, University of Michigan Medical School, Ann Arbor.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Schwartz
authors.affiliation: Department of Dermatology, University of Michigan Medical School, Ann Arbor.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Bichakjian
authors.affiliation: Department of Dermatology, University of Michigan Medical School, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor.
authors.forename: Douglas
authors.initials: D
authors.lastname: Fullen
authors.affiliation: Department of Dermatology, University of Michigan Medical School, Ann Arbor.
authors.forename: Alison B
authors.initials: AB
authors.lastname: Durham
authors.affiliation: Department of Dermatology, University of Michigan Medical School, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor.
authors.forename: Lori
authors.initials: L
authors.lastname: Lowe
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor3Department of Dermatology, University of Michigan Medical School, Ann Arbor5Division of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D047368:Tumor Burden; D055815:Young Adult