title: Clinical factors associated with subclinical spread of in situ melanoma.
abstract: BACKGROUND
  Subclinical spread of in situ melanoma occurs at a wide frequency, ranging from 12% to 71%.
  
  
  OBJECTIVE
  To identify clinical factors associated with subclinical spread of in situ melanoma.
  
  
  METHODS
  We used a retrospective, cross-sectional study of 674 consecutive in situ melanomas to examine 627 patients treated with Mohs surgery and melanoma antigen recognized by T cells 1 immunostaining. The presence of subclinical spread was correlated with clinical characteristics. Univariate and multivariate logistic regression analyses were performed to generate odds ratios (ORs) and 95% confidence intervals (CIs).
  
  
  RESULTS
  Both univariate and multivariate analyses demonstrated significantly increased odds for subclinical spread of in situ melanomas when they were located on the head or neck, at acral sites, or on the pretibial leg (OR 1.97, 95% CI 1.41-3.40); in persons with a history of prior treatment (OR 2.77, 95% CI 1.74-4.420); melanomas of preoperative size >1 cm (OR 1.74, 95% CI 1.23-2.46, P = .002); or in persons ≥60 years old (OR 1.47, 95% CI 1.01-2.13, P = .042). A count prediction model demonstrated that the risk for subclinical spread increased with the number of clinical risk factors.
  
  
  CONCLUSIONS
  We used a single-site, retrospective study design.
  
  
  CONCLUSIONS
  Clarifying the risk factors for subclinical spread might help to refine triage of in situ melanomas to the appropriate surgical techniques for margin assessment prior to reconstruction.
authors.affiliation: Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: Thuzar.Shin@uphs.upenn.edu.
authors.forename: Thuzar M
authors.initials: TM
authors.lastname: Shin
authors.affiliation: Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Etzkorn
authors.affiliation: Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Sobanko
authors.affiliation: Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David J
authors.initials: DJ
authors.lastname: Margolis
authors.affiliation: Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gelfand
authors.affiliation: Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Emily Y
authors.initials: EY
authors.lastname: Chu
authors.affiliation: Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Rosalie
authors.initials: R
authors.lastname: Elenitsas
authors.affiliation: Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Waqas R
authors.initials: WR
authors.lastname: Shaikh
authors.affiliation: Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D065426:Cytoreduction Surgical Procedures; D005260:Female; D005385:Fingers; D005534:Foot Diseases / Q000276:immunology / Q000473:pathology / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000276:immunology / Q000473:pathology / Q000601:surgery; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000276:immunology / Q000473:pathology / Q000601:surgery; D007121:Immunocompetence; D007866:Leg; D008297:Male; D008545:Melanoma / Q000276:immunology / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D015580:Mohs Surgery; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D018365:Neoplasm, Residual; D009928:Organ Specificity; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000276:immunology / Q000473:pathology* / Q000601:surgery; D014034:Toes; D055815:Young Adult; D000096142:Cutaneous Malignant Melanoma
keywords: Mohs micrographic surgery; appropriate use criteria; excision; lentigo maligna; melanoma in situ; subclinical spread