title: Clinical and pathologic factors associated with subclinical spread of invasive melanoma.
abstract: BACKGROUND
  Indications to treat invasive melanoma with Mohs micrographic surgery (MMS) or analogous techniques with exhaustive microscopic margin assessment have not been defined.
  
  
  OBJECTIVE
  Identify clinical and histologic factors associated with subclinical spread of invasive melanoma.
  
  
  METHODS
  This retrospective, cross-sectional study evaluated 216 invasive melanomas treated with MMS and melanoma antigen recognized by T cells 1 immunostaining. Logistic regression models were used to correlate clinicopathologic risk factors with subclinical spread and construct a count prediction model.
  
  
  RESULTS
  Risk factors associated with subclinical spread by multivariate analysis included tumor localization on the head and neck (OR 3.28, 95% confidence interval [CI] 1.16-9.32), history of previous treatment (OR 4.18, 95% CI 1.42-12.32), age ≥65 (OR 4.45, 95% CI 1.29-15.39), and ≥1 mitoses/mm2(OR 2.63, 95% CI 1.01-6.83). Tumor thickness and histologic subtype were not associated with subclinical spread. The probability of subclinical spread increased per number of risk factors, ranging from 9.22% (95% CI 2.57%-15.86%) with 1 factor to 80.32% (95% CI 68.13%-92.51%) with 5 factors.
  
  
  CONCLUSIONS
  This study was conducted at a single academic institution with a small study population using a retrospective study design that was subject to potential referral bias.
  
  
  CONCLUSIONS
  Clinical and histologic factors identify invasive melanomas that are at increased risk for subclinical spread and might benefit from MMS or analogous techniques 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: Waqas R
authors.initials: WR
authors.lastname: Shaikh
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: Christopher J
authors.initials: CJ
authors.lastname: Miller
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; 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; D058965:MART-1 Antigen / Q000032:analysis / Q000276:immunology; D008297:Male; D008545:Melanoma / Q000276:immunology / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D008940:Mitotic Index; D015580:Mohs Surgery; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D018365:Neoplasm, Residual; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000276:immunology / Q000473:pathology* / Q000601:surgery; D013601:T-Lymphocytes / Q000276:immunology; D000096142:Cutaneous Malignant Melanoma
chemical_list: D058965:MART-1 Antigen
keywords: Mohs micrographic surgery; appropriate use criteria; excision; invasive melanoma; subclinical spread