1
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Trischman T, Bangalore Kumar A, Asamoah EM, Todd A, Vidal NY, Demer AM. Risk factors associated with tumor upstaging in melanomas treated with Mohs micrographic surgery with melanocytic immunohistochemistry. JAAD Int 2024; 16:3-8. [PMID: 38756446 PMCID: PMC11096738 DOI: 10.1016/j.jdin.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 05/18/2024] Open
Abstract
Background Mohs micrographic surgery with melanocytic immunohistochemistry (MMS-I) is increasingly utilized for special site melanoma treatment. Yet, frequency and risk factors associated with upstaging of all-stage cutaneous melanomas treated with MMS-I remain undefined. Objective Determine upstaging frequency and factors associated with tumor upstaging for all-stage melanomas treated with MMS-I. Methods In this retrospective, single-center case series, all cases of invasive and in situ melanoma treated with MMS-I between 2008 and 2018 were reviewed. Patient and tumor characteristics were recorded and compared between tumors that were and were not upstaged from their initial T stage. Results Of the 962 melanoma MMS-I cases identified, 44 (4.6%) were upstaged, including 5.6% of in situ and 2.5% of invasive tumors. Risk factors for upstaging included lack of excisional intent at the time of initial biopsy (P < .01), nonlentigo maligna subtype (P = .03), female sex (P = .02), and initial in situ diagnosis (P = .03). Nonstatistically significant characteristics evaluated included patient age (P = .97), initial Breslow depth (P = .18), and biopsy type (P = .24). Limitations Retrospective study design. Conclusions All-stage cutaneous melanomas treated with MMS-I are associated with low upstaging rates. Tumor upstaging is associated with lack of excisional intent, female sex, and in situ tumors.
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Affiliation(s)
| | | | | | - Austin Todd
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Nahid Y. Vidal
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
- Division of Dermatologic Surgery, Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Addison M. Demer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
- Division of Dermatologic Surgery, Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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2
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Fan F, Gou J, Li S, Ji Q. A Prognostic Model for Cancer-Specific Survival Among Patients with Nodular Melanoma in Head and Neck. Laryngoscope 2024; 134:3611-3619. [PMID: 38400783 DOI: 10.1002/lary.31342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 01/06/2024] [Accepted: 01/26/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES This study aims to evaluate the correlation between risk factors and treatment methods affecting nodular melanoma (NM) in the head and neck, as well as cancer-specific survival (CSS), and provide personalized predictive tools for clinical physicians. METHODS The retrospective study data of 1848 patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. All variables were included in the correlation analysis using the Spearman method. Significant prognostic factors were extracted and integrated through Cox risk regression analysis to construct a nomogram. To assess the performance of the nomogram, Harrell's concordance index (C-index) and a receiver operating characteristic (ROC) curve analysis were employed. RESULTS Spearman's correlation analysis revealed a positive correlation between radiotherapy and lymph node metastasis, whereas chemotherapy showed a stronger association with distant metastasis. However, Cox risk regression analysis demonstrated that Mohs surgery and wide excision with margins exceeding 1 cm yielded substantial therapeutic advantages. Five independent risk prognostic factors (Breslow thickness, ulceration, N classification, M classification, and surgery type) were employed to construct a nomogram. The C-index for this nomogram was 0.713 for the training set and 0.720 for the validation set. In the training set, the 3-, 5-, and 8-year areas under the curve (AUCs) for CSS were 0.752, 0.723, and 0.720, whereas the validation set's AUCs were 0.754, 0.763, and 0.760, respectively. Calibration curves indicated the nomogram's strong discriminative ability for predicting CSS. CONCLUSION In this study, we identified independent prognostic factors for patients with NM in head and neck and developed a relatively accurate model to predict the survival probability of them, which could contribute to the tumor assessment and clinical decision-making. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3611-3619, 2024.
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Affiliation(s)
- Fangli Fan
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Juxiang Gou
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Shulian Li
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Ji
- Department of Aesthetic Plastic Surgery, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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3
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Sharma AN, Kassels A, Brewer JD, Demer AM. Female Breast Melanomas are Associated With Lower Stage Diagnosis and Decreased Mohs Utilization: A National Cohort Study. Dermatol Surg 2024:00042728-990000000-00851. [PMID: 38900087 DOI: 10.1097/dss.0000000000004296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Affiliation(s)
- Ajay N Sharma
- Department of Dermatology, University of California, Irvine, California
| | - Alexa Kassels
- Department of Dermatology, University of California, Irvine, California
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Addison M Demer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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4
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Rames MM, Campbell E, Asamoah E, Trischman T, Kumar AB, Vidal NY, Demer A. Mohs Micrographic Surgery for Invasive Melanoma Allows for Tissue Preservation Compared With Wide Local Excision: A Retrospective Cohort Study. Dermatol Surg 2024:00042728-990000000-00845. [PMID: 38888235 DOI: 10.1097/dss.0000000000004270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
BACKGROUND While increasing evidence supports the safety and effectiveness of immunohistochemistry-assisted Mohs micrographic surgery (MMS) for superficially invasive melanoma, there is a paucity of the literature investigating its effect on final defect size. OBJECTIVE To evaluate the tissue sparing effect of MMS for melanoma. MATERIALS AND METHODS Three hundred and twenty-eight patients with early-stage (T1a/T1b) cutaneous melanomas treated with MMS from January 2008 to December 2018 were evaluated. Measured defect sizes after Mohs tumor extirpation were compared with anticipated defect size that would result from standard-margin wide local excision (WLE). Average actual versus anticipated defect areas were compared using a paired t-test (95% confidence intervals). RESULTS The following groups demonstrated a significantly smaller defect area for MMS-treated tumors when compared with anticipated standard-margin WLE defect: All tumors combined (13.8 cm2 vs 10.4 cm2, p < .001), tumors requiring 1 stage (13.6 cm2 vs 10.1 cm2,p < .001), and tumors requiring 2 stages (13.2 cm2 vs 10.5 cm2, p = .004). The majority of patients (83.5%, n = 274) achieved clear margins with 1 stage. CONCLUSION Immunohistochemistry-assisted MMS for early-stage invasive melanoma is associated with smaller final defect size and overall tissue sparing effect compared with standard WLE margins.
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Affiliation(s)
- Melissa M Rames
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Elliott Campbell
- Division of Dermatologic Surgery, Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Eucabeth Asamoah
- Division of Dermatologic Surgery, Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Nahid Y Vidal
- Division of Dermatologic Surgery, Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Addison Demer
- Division of Dermatologic Surgery, Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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5
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Mansilla-Polo M, Morgado-Carrasco D, Toll A. Review on the Role of Paraffin-embedded Margin-controlled Mohs Micrographic Surgery to Treat Skin Tumors. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:555-571. [PMID: 38395222 DOI: 10.1016/j.ad.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/29/2023] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Paraffin-embedded margin-controlled Mohs micrographic surgery (PMMS) includes various procedures such as slow Mohs or deferred Mohs technique, the Muffin and Tübingen techniques, and staged margin excision, or the spaghetti technique. PMMS is a variation of conventional Mohs micrographic surgery (MMS) that allows histopathological examination with delayed margin control. PMMS requires minimum training and may be adopted by any hospital. The setback is that PMMS can require procedures across multiple days. PMMS lowers the rate of recurrence of basal cell carcinoma vs wide local excision in high-risk basal cell carcinoma, and improves the rates of recurrence and survival in lentigo maligna. PMMS can be very useful in high-risk squamous cell carcinoma treatment. Finally, it is a promising technique to treat infrequent skin neoplasms, such as dermatofibrosarcoma protuberans, or extramammary Paget's disease, among others. In this article, we present a literature narrative review on PMMS, describing techniques and indications, and highlighting long-term outcomes.
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Affiliation(s)
- M Mansilla-Polo
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Health Research Institute (IIS) La Fe, Valencia, Spain
| | - D Morgado-Carrasco
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Dermatology, Hospital de Figueres, Fundació Alt Empordà, Spain
| | - A Toll
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
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6
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Mansilla-Polo M, Morgado-Carrasco D, Toll A. Review on the Role of Paraffin-embedded Margin-controlled Mohs Micrographic Surgery to Treat Skin Tumors. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T555-T571. [PMID: 38648936 DOI: 10.1016/j.ad.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/29/2023] [Accepted: 02/06/2024] [Indexed: 04/25/2024] Open
Abstract
Paraffin-embedded margin-controlled Mohs micrographic surgery (PMMS) includes various procedures such as slow Mohs or deferred Mohs technique, the Muffin and Tübingen techniques, and staged margin excision, or the spaghetti technique. PMMS is a variation of conventional Mohs micrographic surgery (MMS) that allows histopathological examination with delayed margin control. PMMS requires minimum training and may be adopted by any hospital. The setback is that PMMS can require procedures across multiple days. PMMS lowers the rate of recurrence of basal cell carcinoma vs wide local excision in high-risk basal cell carcinoma, and improves the rates of recurrence and survival in lentigo maligna. PMMS can be very useful in high-risk squamous cell carcinoma treatment. Finally, it is a promising technique to treat infrequent skin neoplasms, such as dermatofibrosarcoma protuberans, or extramammary Paget's disease, among others. In this article, we present a literature narrative review on PMMS, describing techniques and indications, and highlighting long-term outcomes.
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Affiliation(s)
- M Mansilla-Polo
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, España; Health Research Institute (IIS) La Fe, Valencia, España
| | - D Morgado-Carrasco
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España; Department of Dermatology, Hospital de Figueres, Fundació Alt Empordà, España
| | - A Toll
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España.
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7
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Shah P, Trepanowski N, Grant-Kels JM, LeBoeuf M. Mohs micrographic surgery in the surgical treatment paradigm of melanoma in situ and invasive melanoma: A clinical review of treatment efficacy and ongoing controversies. J Am Acad Dermatol 2024:S0190-9622(24)00756-4. [PMID: 38768857 DOI: 10.1016/j.jaad.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 04/06/2024] [Accepted: 05/11/2024] [Indexed: 05/22/2024]
Abstract
Mohs Micrographic Surgery (MMS) for treatment of melanoma offers several advantages over wide local excision (WLE), including complete histologic margin evaluation, same-day resection and closure, and sparing of healthy tissue in critical anatomic sites. Recently, a large volume of clinical data demonstrating efficacy in MMS treatment of melanoma was published, leading to emerging patient safety considerations of incurred treatment costs, risk of tumor upstaging, and failure of care coordination for sentinel lymph node biopsy (SLNB). MMS offers a safe, effective, and value-based treatment for both melanoma in situ (MIS) and invasive melanoma (IM), particularly with immunohistochemistry use on frozen sections. Compared to wide local excision, MMS treatment demonstrates similar or improved outcomes for local tumor recurrence, melanoma-specific survival, and overall survival at long-term follow-up. Tumor upstaging risk is low, and if present, alteration to clinical management is minimal. Discussion of SLNB for eligible head and neck IM cases should be done prior to MMS. Though challenging, successful multidisciplinary coordination of SLNB with MMS has been demonstrated. Herein, we provide a detailed clinical review of evidence for MMS treatment of cutaneous melanoma and offer recommendations to address current controversies surrounding the evolving paradigm of surgical management for both MIS and invasive melanoma (IM).
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Affiliation(s)
- Payal Shah
- Department of Dermatology, Dartmouth Health, Lebanon, New Hampshire
| | - Nicole Trepanowski
- Department of Dermatology, Dartmouth Health, Lebanon, New Hampshire; Department of Medicine, Dartmouth Health, Lebanon, New Hampshire
| | - Jane M Grant-Kels
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida; Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Matthew LeBoeuf
- Department of Dermatology, Dartmouth Health, Lebanon, New Hampshire.
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8
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Freeman SC, Dacy NN, Neill BC, Chisholm C, Tolkachjov SN. Intraneural Melanoma Identified With MART-1 Immunostaining in Mohs Micrographic Surgery. Cureus 2024; 16:e58920. [PMID: 38800274 PMCID: PMC11121584 DOI: 10.7759/cureus.58920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Mohs micrographic surgery (MMS) utilizing melanoma antigen recognized by T-cells (MART-1) immunostaining is an increasingly common method of treatment for minimally invasive melanoma in anatomically constrained areas such as the face, ears, or acral sites. Neurotropic melanoma, also known as neurotrophism in melanoma, refers to the invasion of melanoma cells into the nerves. As such, these tumors can extend well beyond anticipated clinical tumor margins which can increase the risk of local recurrence. Here, we present a case of neurotropic melanoma successfully identified during MMS using MART-1 immunostaining, which was then confirmed with permanent sectioning.
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Affiliation(s)
- S Caleb Freeman
- Dermatology, Oregon Health & Science University, Portland, USA
| | - Nicole N Dacy
- Dermatology, Baylor Scott & White Medical Center, Temple, USA
| | - Brett C Neill
- Dermatology and Mohs Micrographic Surgery, Swann Dermatology, Springfield, USA
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9
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Tate JA, Matsumoto A, Greif C, Lim J, Nijhawan RI, Srivastava D. Excision margins for melanoma in situ on the head and neck-A single-center 10-year retrospective review of treatment with Mohs micrographic surgery. J Am Acad Dermatol 2024:S0190-9622(24)00102-6. [PMID: 38253130 DOI: 10.1016/j.jaad.2023.12.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/03/2023] [Accepted: 12/16/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Although current guidelines recommend a 5 mm surgical margin for the excision of melanoma in situ (MIS), increasing evidence has shown this may be suboptimal to achieve tumor clearance. OBJECTIVE To evaluate margins required for optimal cure rates with excision of MIS on the head and neck and investigate tumor and/or patient factors in those requiring >5 mm margins to achieve tumor clearance. METHODS A retrospective chart review was performed on 846 (807 primary and 39 recurrent) MIS cases on the head and neck treated in the authors' dermatologic surgery department over a 126-month (10.5 year) period. RESULTS Sixty-two percent were cleared with 5 mm margins. A total of 15 mm margins were required to achieve a 97% clearance rate. Difference in clearance rate between margin thresholds was significant (P < .001). Tumor location on the cheek and larger preoperative size correlated with requiring >5 mm margins to achieve tumor clearance (P = .006 and P = .001, respectively). LIMITATIONS This is a single-center retrospective study which relies on accurate documentation of clinical data. CONCLUSION This study demonstrates that MIS on the head and neck often requires margins >5 mm margins to achieve tumor clearance. When Mohs micrographic surgery is not possible, excision margins of ≥10 mm are likely necessary for head and neck tumors.
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Affiliation(s)
- Jesalyn A Tate
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrew Matsumoto
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Charlotte Greif
- University of Texas Southwestern School of Medicine, Dallas, Texas
| | - Jorena Lim
- University of Texas Southwestern School of Medicine, Dallas, Texas
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Divya Srivastava
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
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10
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Levy JJ, Davis MJ, Chacko RS, Davis MJ, Fu LJ, Goel T, Pamal A, Nafi I, Angirekula A, Suvarna A, Vempati R, Christensen BC, Hayden MS, Vaickus LJ, LeBoeuf MR. Intraoperative margin assessment for basal cell carcinoma with deep learning and histologic tumor mapping to surgical site. NPJ Precis Oncol 2024; 8:2. [PMID: 38172524 PMCID: PMC10764333 DOI: 10.1038/s41698-023-00477-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/14/2023] [Indexed: 01/05/2024] Open
Abstract
Successful treatment of solid cancers relies on complete surgical excision of the tumor either for definitive treatment or before adjuvant therapy. Intraoperative and postoperative radial sectioning, the most common form of margin assessment, can lead to incomplete excision and increase the risk of recurrence and repeat procedures. Mohs Micrographic Surgery is associated with complete removal of basal cell and squamous cell carcinoma through real-time margin assessment of 100% of the peripheral and deep margins. Real-time assessment in many tumor types is constrained by tissue size, complexity, and specimen processing / assessment time during general anesthesia. We developed an artificial intelligence platform to reduce the tissue preprocessing and histological assessment time through automated grossing recommendations, mapping and orientation of tumor to the surgical specimen. Using basal cell carcinoma as a model system, results demonstrate that this approach can address surgical laboratory efficiency bottlenecks for rapid and complete intraoperative margin assessment.
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Affiliation(s)
- Joshua J Levy
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA.
- Emerging Diagnostic and Investigative Technologies, Clinical Genomics and Advanced Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03756, USA.
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA.
- Program in Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA.
| | - Matthew J Davis
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
| | | | - Michael J Davis
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
| | - Lucy J Fu
- Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
| | - Tarushii Goel
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
- Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Akash Pamal
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
- University of Virginia, Charlottesville, VA, 22903, USA
| | - Irfan Nafi
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
- Stanford University, Palo Alto, CA, 94305, USA
| | - Abhinav Angirekula
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
- University of Illinois Urbana-Champaign, Champaign, IL, 61820, USA
| | - Anish Suvarna
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
| | - Ram Vempati
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
| | - Brock C Christensen
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
| | - Matthew S Hayden
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
| | - Louis J Vaickus
- Emerging Diagnostic and Investigative Technologies, Clinical Genomics and Advanced Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03756, USA
| | - Matthew R LeBoeuf
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
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11
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Elgash M, Young J, White K, Leitenberger J, Bar A. An Update and Review of Clinical Outcomes Using Immunohistochemical Stains in Mohs Micrographic Surgery for Melanoma. Dermatol Surg 2024; 50:9-15. [PMID: 37738278 DOI: 10.1097/dss.0000000000003945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) provides optimal margin control through complete peripheral and deep margin assessment. The treatment of melanoma using MMS has historically been limited by difficulty in interpreting melanocytes using frozen sections. Immunohistochemical (IHC) staining, a technique whereby chromogen-tagged antibodies are used to detect antigens of interest, has revolutionized the surgical treatment of melanoma. OBJECTIVES This article provides an update and literature review of current IHC stains used in MMS for melanoma, their sensitivities and specificities, and clinical outcomes. MATERIALS AND METHODS A PubMed search was performed using keywords including "immunohistochemistry," "staining," and "Mohs surgery." Articles related to the use of IHC staining for the treatment of melanoma with MMS were included. RESULTS Six IHC stains met the criteria for the review including melanoma antigen recognized by T cells (MART-1), SRY-related HMG-box (SOX10), microphthalmia-associated transcription factor, HMB-45, MEL-5, S-100, and preferentially expressed antigen in melanoma. CONCLUSION The adaptation of IHC methods to frozen sections has enabled MMS to become a preferred treatment option for melanoma in special-site areas. Future studies are needed to standardize IHC techniques and to define best practices when using frozen section in the treatment of melanoma.
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Affiliation(s)
- May Elgash
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Jade Young
- Oregon Health and Science University, School of Medicine, Portland, Oregon
| | - Kevin White
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Justin Leitenberger
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Anna Bar
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
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12
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Isaq NA, Demer AM, Vidal NY, Lohman ME. Dermatologic surgeons' approaches to acral lentiginous melanoma: a survey of the American College of Mohs Surgery. Arch Dermatol Res 2023; 316:17. [PMID: 38059993 DOI: 10.1007/s00403-023-02744-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/09/2023] [Accepted: 10/26/2023] [Indexed: 12/08/2023]
Abstract
Acral lentiginous melanoma (ALM) is a subtype of melanoma that primarily affects ethnic minorities and is associated with poor outcomes. Racial inequalities in melanoma survival, particularly between Blacks and Whites, have been well documented in the literature. There are limited data on the role of surgical approach to ALM and its contribution to the existing disparities in ALM survival. Thus, this study aimed to investigate the role of surgical approach to ALM among Mohs surgeons. The survey was distributed to members of the American College of Mohs Surgery (ACMS), with 43 physicians completing the survey. The results showed that there was no consensus among Mohs surgeons regarding the surgical approach for ALM, even for advanced stages. 74% respondents performed complete circumferential peripheral and deep margin assessment (CCPDMA) for ALM, including Mohs micrographic surgery (MMS) or en face staged excision. However, barriers such as limited training, low comfort operating on acral sites, and inadequate access to specialized biopsies were reported. Treatment recommendations varied widely regardless of the ALM stage, with no significant differences based on exposure to ALM during training, practice setting, or percent of skin of color patients served. These findings highlight the lack of guidelines and the need for more data on outcomes to support optimal management of ALM. The study emphasizes the importance of addressing healthcare disparities and improving survival outcomes, particularly for ethnic minorities affected by ALM. Consensus guidelines could help standardize treatment approaches and potentially reduce disparities in ALM management.
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Affiliation(s)
- Nasro A Isaq
- Department of Dermatology, Mayo Clinic School of Graduate Medical Education, Rochester, MN, USA
| | - Addison M Demer
- Department of Dermatology, Division of Dermatologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Nahid Y Vidal
- Department of Dermatology, Division of Dermatologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Mary E Lohman
- Department of Dermatology, Division of Dermatologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
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13
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Pearlman RL, O'Hern KJ, Demer AM, Zeng C, Liszewski W. Survival outcomes after Mohs micrographic surgery are equivalent to wide local excision for treatment of Merkel cell carcinoma of the head and neck. Arch Dermatol Res 2023; 315:3003-3004. [PMID: 37819603 DOI: 10.1007/s00403-023-02724-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 07/27/2023] [Accepted: 09/06/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Ross L Pearlman
- Department of Dermatology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Keegan J O'Hern
- Department of Dermatology, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Addison M Demer
- Department of Dermatology, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | | | - Walter Liszewski
- Division of Cancer Epidemiology, Northwestern Feinberg Department of Dermatology, 676 N St Clair St, Chicago, IL, 60611, USA.
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14
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Rosenthal A, Juhasz M, Lask G, Gharavi N. From Centimeters to Millimeters: The Evolution of the Surgical Margins for Melanoma-A Historical Review. Dermatol Surg 2023; 49:1058-1060. [PMID: 37656813 DOI: 10.1097/dss.0000000000003926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
BACKGROUND With an improved understanding of tumor biology and behavior, the recommended margins for the surgical treatment of melanoma have evolved. OBJECTIVE We describe the progression of these surgical margins, detailing the historical basis for the 5-cm margin and transitioning to current practice, in which Mohs micrographic surgery (MMS) with immunohistochemistry (IHC) has become increasingly used. METHODS/MATERIALS We searched PubMed and Google Scholar for articles published between January 2019 and April 2023 describing the use of MMS for melanoma in situ (MIS) and invasive melanomas. RESULTS We identified 12 articles focusing on the use of MMS for MIS and invasive melanomas: 3 meta-analyses and 9 retrospective studies. Two retrospective analyses documented no differences in overall survival between MMS and wide local excision (WLE) and 2 found improved overall survival for MMS compared with WLE. Three retrospective analyses and 3 meta-analyses demonstrated low recurrence rates after the use of MMS for both MIS and invasive melanomas. Finally, 2 retrospective studies documented the success of MMS with IHC using MART-1. CONCLUSION Over the past century, the surgical margins for the treatment of melanoma have undergone a marked transformation. MMS with IHC has become increasingly popular given its ability to reliably produce superior clinical outcomes.
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Affiliation(s)
- Amanda Rosenthal
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Margit Juhasz
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
- Department of Dermatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Gary Lask
- Division of Dermatology, University of California, Los Angeles, California
| | - Nima Gharavi
- Department of Dermatology, Cedars-Sinai Medical Center, Los Angeles, California
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15
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Albero-González R, Marti-Marti I, Alós L, Castillo P, Castrejón N, Alegre M, Morgado-Carrasco D, Pérez-Ánker J, Pina N, Godoy C, Martínez A, García A, Toll A. Margin control of lentigo maligna with SOX10-frozen section immunostaining: A case series. Australas J Dermatol 2023; 64:544-546. [PMID: 37461823 DOI: 10.1111/ajd.14132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/05/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Raquel Albero-González
- Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Ignasi Marti-Marti
- Department of Dermatology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Llúcia Alós
- Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Paola Castillo
- Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Natàlia Castrejón
- Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marta Alegre
- Department of Dermatology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | - Núria Pina
- Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Cristina Godoy
- Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Antonio Martínez
- Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Adriana García
- Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Agustí Toll
- Universitat de Barcelona, Barcelona, Spain
- Department of Dermatology, Hospital Clínic de Barcelona, Barcelona, Spain
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16
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Beal BT, Udkoff J, Aizman L, Etzkorn J, Zitelli JA, Miller CJ, Shin TM, Sobanko JF, Brodland DG. Outcomes of invasive melanoma of the head and neck treated with Mohs micrographic surgery - A multicenter study. J Am Acad Dermatol 2023; 89:544-550. [PMID: 36642331 DOI: 10.1016/j.jaad.2022.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/16/2022] [Accepted: 12/07/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND There are no randomized controlled trials to guide surgical margins for invasive head and neck (H&N) melanoma using conventional excision. Mohs micrographic surgery (MMS) has shown improved local recurrence rates and survival for invasive H&N melanomas. OBJECTIVE Determine local recurrence (LR), nodal recurrence, and distant recurrence rates, and disease specific survival for invasive melanoma of the H&N treated with MMS. METHODS A retrospective multicenter study of 785 cases of invasive H&N melanoma treated with MMS using frozen sections with melanoma antigen recognized by T-cells 1 immunohistochemical staining was performed to evaluate long-term outcomes over 12-years. RESULTS 785 melanomas (thickness: 0.3 mm-8.5 mm) were treated with MMS. LR, nodal recurrence, and distant recurrence rates were 0.51% (4/785), 1.0% (8/785), and 1.1% (9/785) respectively. For T1, T2, T3, and T4 tumors LR was 0.16% (1/636), 1.18% (1/85), 2.22% (1/45), and 5.26% (1/19), respectively. Five and 10-year disease specific survival were 96.8% (95% CI 95.0% to 98.5%) and 93.4% (95% CI 88.5% to 98.3%). LIMITATIONS A nonrandomized retrospective study. CONCLUSION MMS achieves significant improvements in LR compared to a meta-analysis of historical cohorts of patients treated with conventional excision. MMS should be considered an important surgical option for invasive H&N melanoma.
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Affiliation(s)
- Brandon T Beal
- St. Louis Dermatology & Cosmetic Surgery, St. Louis Skin Cancer Specialists, Troy, Missouri.
| | - Jeremy Udkoff
- Department of Dermatology, University of Pittsburgh Medical Center, Philadelphia, Pennsylvania
| | - Leora Aizman
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jeremy Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John A Zitelli
- University of Pittsburgh Medical Center, Zitelli & Brodland, PC, Pittsburgh, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David G Brodland
- University of Pittsburgh Medical Center, Zitelli & Brodland, PC, Pittsburgh, Pennsylvania
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17
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Zhang S, Wang Y, Fang K, Jia Q, Zhang H, Qu T. Slow Mohs micrographic surgery for nail apparatus melanoma in situ. Int J Dermatol 2023; 62:1170-1175. [PMID: 37350436 DOI: 10.1111/ijd.16748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/18/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Nail apparatus melanoma is a malignant tumor with a high incidence in Chinese melanoma patients. Slow Mohs micrographic surgery is an emerging technique for treating nail apparatus melanoma in situ (NAMIS). OBJECTIVE This study evaluated the efficacy and safety of slow Mohs micrographic surgery for treating NAMIS. METHODS Patients were enrolled in this retrospective study and treated in a single center from October 1, 2016, to June 30, 2022. Each patient underwent standard slow Mohs micrographic surgery, and follow-up was regularly conducted at clinics. RESULTS Ten patients were enrolled in the study. Two patients underwent one Mohs stage, seven underwent two Mohs stages, and one underwent seven Mohs stages. The resection margin ranged from 5 to 25 mm. No severe complications were reported in the treatment, and recurrence of NAMIS was not observed during the follow-up period. CONCLUSION Slow Mohs micrographic surgery is a valuable surgical method to treat NAMIS that preserves digit function and can be well tolerated by patients.
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Affiliation(s)
- Shu Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Yuanzhuo Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Kai Fang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Qiannan Jia
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Hanlin Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Tao Qu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, China
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18
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O’Hern K, Liszewski W, Vidal NY, Demer A. Increasing utilization of Mohs micrographic surgery for melanoma in the United States: A National Cancer Database analysis. JAAD Int 2023; 11:92-94. [PMID: 36941914 PMCID: PMC10023893 DOI: 10.1016/j.jdin.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Affiliation(s)
- Keegan O’Hern
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
- Correspondence to: Keegan O’Hern, MD, Department of Dermatology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Walter Liszewski
- Department of Dermatology, Northwestern University, Chicago, Illinois
- Department of Preventative Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University, Chicago, Illinois
| | - Nahid Y. Vidal
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Addison Demer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota
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19
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Knackstedt TJ. Differences in sentinel lymph node biopsy utilization in eligible melanoma patients treated with Mohs micrographic surgery or wide local excision: A population-based logistic regression model and survival analysis. J Am Acad Dermatol 2023; 88:848-855. [PMID: 36368376 DOI: 10.1016/j.jaad.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/14/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Primary melanoma management relies on tumor extirpation and staging sentinel lymph node biopsy (SLNB) in eligible patients. This study compares SLNB utilization in patients undergoing wide local excision (WLE) or Mohs micrographic surgery (MMS). METHODS American Joint Committee on Cancer seventh edition ≥ patients with T1b melanoma undergoing WLE or MMS in the Surveillance, Epidemiology, and End Results program were included. Propensity score matching was performed to compare patients who underwent MMS or WLE. Kaplan-Meier analysis and Fine-Gray cumulative incidence functions were used for overall and melanoma-specific survival. RESULTS Eight hundred twenty-five MMS cases and 38,760 WLE cases were identified. SLNB was performed in 32.61% of MMS patients and 61.77% of WLE patients with positive rates of 12.5% and 14.82%, respectively. Multiple logistic regression of factors associated with SLNB utilization revealed that WLE, male gender, younger age, extremity location, and nodular and rare melanoma subtypes were significantly associated with increased odds of receiving SLNB whereas head and neck location and lentigo maligna melanoma subtype were significantly less likely to receive SLNB. LIMITATIONS Potential selection bias from a retrospective data set. CONCLUSION Patients receiving WLE for ≥ T1b melanoma are more likely to receive a SLNB than patients undergoing MMS.
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Affiliation(s)
- Thomas J Knackstedt
- Department of Dermatology, MetroHealth System, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
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20
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Huerta T, Swetter SM, Nehal KS, Coit DG, Bichakjian CK, Durham AB. Current evidence does not support Mohs micrographic surgery or staged excision as equivalent to wide excision for primary cutaneous melanoma. J Am Acad Dermatol 2023; 88:959-960. [PMID: 36535532 DOI: 10.1016/j.jaad.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Tomas Huerta
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Susan M Swetter
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California
| | - Kishwer S Nehal
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel G Coit
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Alison B Durham
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
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21
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Neill BC, Siscos SM, Bar AA, Seger EW, Latour E, Tolkachjov SN. Factors Influencing General Dermatologists When Referring Patients With Head and Neck Melanoma for Mohs Micrographic Surgery: A Nationwide Cross-Sectional Survey. Dermatol Surg 2023; 49:451-455. [PMID: 36989088 DOI: 10.1097/dss.0000000000003754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) for cutaneous melanoma has demonstrated higher cure rates, lower local recurrence rates, and improved survival compared with wide local excision (WLE). However, factors affecting referrals by general dermatologists for MMS of head and neck melanoma (HNM) are unknown. OBJECTIVE To elucidate referral factors and treatment perspectives of general dermatologists regarding MMS for melanoma in situ (MIS)/lentigo maligna (LM) and early-stage melanoma on the head and neck. MATERIALS AND METHODS A cross-sectional analysis was performed using survey responses of general dermatologists with membership in the American Academy of Dermatology. RESULTS A total of 231 and 132 of the 402 responding general dermatologists routinely referred melanoma in situ MIS/LM and early invasive melanoma for MMS, respectively. Lack of local access to a Mohs surgeon was the most common deterring reason for MIS/LM referral to MMS, whereas the preference for WLE was the most common deterring reason for early invasive melanoma. CONCLUSION Lack of local access to a Mohs surgeon treating HNM with MMS is the primary barrier in referrals to Mohs surgeons for MIS and LM. Among general dermatologists, WLE is preferred for early invasive HNM.
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Affiliation(s)
- Brett C Neill
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Spyros M Siscos
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas
| | - Anna A Bar
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Edward W Seger
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas
| | - Emile Latour
- Biostatistician, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
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22
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Challenges in the Complex Management of Neglected Cutaneous Melanomas in the Head and Neck Area: A Single Center Experience. J Clin Med 2023; 12:jcm12051910. [PMID: 36902697 PMCID: PMC10004111 DOI: 10.3390/jcm12051910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
Familiar controversies in the management of head and neck melanomas are more remarkable in locally advanced cases, and they represent a treatment challenge both surgically and oncologically. In our retrospective study, patients with surgically treated primary malignant melanoma of the head and neck region larger than 3 cm in diameter were included. Five patients met our inclusion criteria. In all cases, wide excision and immediate reconstruction were performed without sentinel lymph node biopsy. The defect on the scalp was covered by a split skin graft, with local flaps chosen for reconstruction on the face on an individual basis. After a 2-6 year follow-up, a good oncological, functional, and esthetic result was achieved. Our results show that in the case of large, locally advanced melanomas, surgical treatment still plays a crucial role that can provide long-term local control and support the effect of systemic treatment.
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23
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Anatomic Region of Cutaneous Melanoma Impacts Survival and Clinical Outcomes: A Population-Based Analysis. Cancers (Basel) 2023; 15:cancers15041229. [PMID: 36831571 PMCID: PMC9954057 DOI: 10.3390/cancers15041229] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
PURPOSE The objective was to determine the effects of the anatomic site of a cutaneous melanoma on the survival outcomes of diagnosed individuals. METHODS We conducted a cross-sectional study using data from the Surveillance, Epidemiology, and End Results Program (SEER) Database from 2004-2014 and included 178,892 cases of individuals diagnosed with cutaneous melanoma. Overall survival (OS) for each anatomic site as well as associated demographics, primary site, stage, and pathologic prognostic factors (Breslow's depth of invasion (DOI), level of mitoses, and ulceration), were analyzed. RESULTS Lower extremity melanoma (LEM) was the most likely to have locoregional nodal spread, yet head and neck melanoma (HNM) was the most likely to present at the most advanced stage of disease (IV). Independent of other factors, HNM was associated with the greatest risk of death (HR 1.90 [95% CI, 1.85-1.96]) compared to other sites, and males experienced worse overall survival (OS) (HR 1.74 [95% CI, 1.70-1.78]) compared to females. The last and greatest risk of death is associated with LEM and HNM, respectively. CONCLUSION Given these survival differences, consideration should be given to incorporating the primary site of melanoma into staging to ensure treatment is efficacious as possible.
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24
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Zijlker LP, Eggermont AMM, van Akkooi ACJ. The end of wide local excision (WLE) margins for melanoma ? Eur J Cancer 2023; 178:82-87. [PMID: 36423526 DOI: 10.1016/j.ejca.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/22/2022]
Abstract
CLINICAL QUESTION Is there nowadays any benefit of continuing the practice of routine wide local excision (WLE) for primary stage I/II cutaneous melanoma? BACKGROUND WLE aims to eradicate potential microsatellites around melanomas and thereby reduce local recurrence rates and improve overall survival. Six large prospective randomised trials investigated WLE versus wider WLE, they all failed to show any effect on overall survival (OS). METHODS A literature search was performed to identify data on outcome after omitting WLE. Additionally circumstantial evidence was gathered from pathology studies and outcomes of modified surgical techniques, as well as publications on morbidity. RESULTS No prospective and one retrospective study was found. The retrospective study showed no difference in OS after correction for confounding factors. Pathology studies showed a low incidence of residual melanoma in WLE specimen (0-4.2%). Mohs surgery does not show a difference in recurrence rates or OS. WLE is associated with considerable postoperative morbidity, which increases with wider excision margins. CONCLUSION There is no solid prospective evidence to support the classic dogma of a 2-step approach with the use of WLE for primary cutaneous melanoma that has been completely excised on diagnostic excision biopsy. We recommend to setup and conduct a prospective randomised trial to compare the classical 2-step approach with WLE to a complete diagnostic excision only to abolish the routine practice of WLE in the future.
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Affiliation(s)
- Lisanne P Zijlker
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Alexander M M Eggermont
- Faculty of Medicine University Medical Center Utrecht, the Netherlands; Princess Máxima Center, Utrecht, the Netherlands; Comprehensive Cancer Center Munich, Germany, Technical University Munich & Ldwig Maximiliaan University, Munich, Germany
| | - Alexander C J van Akkooi
- Melanoma Institute Australia, Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Sydney, Australia.
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25
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Berman H, Shimshak S, Reimer D, Brigham T, Hedges MS, Degesys C, Tolaymat L. Skin Cancer in Solid Organ Transplant Recipients: A Review for the Nondermatologist. Mayo Clin Proc 2022; 97:2355-2368. [PMID: 36334939 DOI: 10.1016/j.mayocp.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 11/06/2022]
Abstract
Solid organ transplant recipients (SOTRs) are at increased risk for the development of skin cancer compared with the general population, which requires consistent monitoring and management from a multidisciplinary team. The aim of this review is to provide a comprehensive overview for nondermatologist clinicians, outlining skin cancer diagnosis, treatment pearls, and skin cancer prevention strategies as they relate to SOTRs. A comprehensive search of the literature was conducted through the MEDLINE database with search terms including organ transplantation, transplant recipient, skin cancer, cutaneous neoplasms, management, and therapies. The search was limited to the English language and dates ranging from January 1, 2011, to December 28, 2021. All studies were reviewed for inclusion. Skin cancer will develop in more than half of SOTRs at some point in their life, most often nonmelanoma skin cancer such as basal cell carcinoma or squamous cell carcinoma. Melanoma and rarer cutaneous malignant neoplasms, such as Merkel cell carcinoma and Kaposi sarcoma, are also more frequent among SOTRs. A multidisciplinary effort at skin cancer screening and patient education is invaluable to prevent skin cancer-related morbidity and mortality in this population of patients. Reduction in immunosuppressive medications and surgical intervention are effective therapeutic approaches, and more novel systemic therapies including G protein-coupled receptor inhibitors and immune checkpoint inhibitors are possible options when traditional treatment approaches are not feasible. Checkpoint inhibitor therapy, however, comes with the risk of allograft rejection. With a growing and aging SOTR population, it is essential that SOTRs have support from dermatologists and nondermatologists alike in skin cancer prevention and treatment.
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Affiliation(s)
- Hannah Berman
- Department of Dermatology, Mayo Clinic, Jacksonville, FL
| | | | | | - Tara Brigham
- Mayo Clinic Medical Library, Mayo Clinic College of Medicine and Science, Jacksonville, FL
| | - Mary S Hedges
- Department of Internal Medicine, Division of Community Internal Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Leila Tolaymat
- Department of Dermatology, Mayo Clinic, Jacksonville, FL.
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26
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Mohs Micrographic Surgery for Melanoma. Dermatol Clin 2022; 41:79-88. [DOI: 10.1016/j.det.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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27
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Golda N, Hruza G. Mohs Micrographic Surgery. Dermatol Clin 2022; 41:39-47. [DOI: 10.1016/j.det.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Evidence from Clinical Studies Related to Dermatologic Surgeries for Skin Cancer. Cancers (Basel) 2022; 14:cancers14153835. [PMID: 35954498 PMCID: PMC9367341 DOI: 10.3390/cancers14153835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/22/2022] [Accepted: 08/03/2022] [Indexed: 01/20/2023] Open
Abstract
Simple Summary Although significant progress in pharmacotherapy for skin cancer has been made in the past several years, surgical removal of primary skin cancer is still the first choice of treatment unless distant metastases are evident. In the surgical treatment of primary skin tumors, the surgical margin is critical not only for reducing the possibility of tumor recurrence but also for minimizing the cosmetic and functional complications associated with wide local excision. In contrast, dermatologic surgeries including lymph node dissection and skin graft can cause various complications, and these complications are frequently associated with significant morbidity and discomfort. In this review, we summarize the evidence from previous clinical studies regarding the optimal surgical margin for skin cancer and the methods for diminishing the complications associated with dermatologic surgery. Abstract Despite the significant progress made in the past several years in pharmacotherapies for skin cancer, such as BRAF/MEK inhibitors, immune checkpoint inhibitors, and Hedgehog pathway inhibitors, surgical removal of primary skin cancer is still the first choice of treatment unless distant metastases are evident. In cases of lymph node metastases with clinically palpable lymphadenopathy, lymph node dissection (LND) is typically performed for most skin cancers. In the surgical treatment of primary skin tumors, the surgical margin is critical not only for reducing the possibility of tumor recurrence but also for minimizing the cosmetic and functional complications associated with wide local excision. In contrast, dermatologic surgery can cause various complications. Although skin graft is frequently used for reconstruction of the surgical defect, extensive graft necrosis may develop if optimal stabilization of the graft is not obtained. LND also sometimes causes complications such as intraoperative or postoperative bleeding and postoperative lymphoceles. Moreover, as in other types of surgery, surgical site infection, intraoperative anxiety, and intraoperative and postoperative pain may also develop. These complications are frequently associated with significant morbidity and discomfort. In this review, we summarize the evidence from previous clinical studies regarding the optimal surgical margin for skin cancer and the methods for diminishing the complications associated with dermatologic surgery.
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29
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Seger EW, Neill BC, Patel S, Siscos SM, Hocker TLH. Patients are Willing and Successful With Home Suture Removal After Mohs Surgical Procedures. Dermatol Surg 2022; 48:720-725. [PMID: 35451375 DOI: 10.1097/dss.0000000000003471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Suture removal after surgery is low risk; however, it is often performed by a medical provider. The current SARS-CoV-2 pandemic has forced providers to assess means of reducing in-person contact. OBJECTIVE To determine whether patients undergoing Mohs surgery are willing and successful with home suture removal. MATERIALS AND METHODS A prospective study was performed with patients undergoing Mohs surgery. Before their surgery, patients were assessed for their willingness to remove sutures before and after viewing educational material. Patients who were willing to attempt removal were contacted after expected suture removal date to verify success and assess their experience. RESULTS One hundred fifty patients were enrolled in the study. 90.1% were willing to attempt home suture removal. Patients were more willing ( p = .003), more confident ( p = .024), and had lower anxiety ( p = .049) with removal after viewing educational resources. Patients with a history of suture removal were more likely to attempt removal after their procedure ( p = .036). Ninety-seven percent of patients who were willing to attempt suture removal were successful. There were no major complications with removal. CONCLUSION Patients were overwhelmingly successful with suture removal after an educational intervention. Providers should consider providing this option after surgical procedures when clinically appropriate.
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Affiliation(s)
- Edward W Seger
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas
| | - Brett C Neill
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas
| | - Soham Patel
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas
- School of Medicine, University of Kansas, Kansas City, Kansas
| | - Spyros M Siscos
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas
| | - Thomas L H Hocker
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas
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Council ML. Commentary on "Recurrence Rate for Melanoma Excised by Mohs Micrographic Surgery Without Immunostaining". Dermatol Surg 2022; 48:500-501. [PMID: 35389921 DOI: 10.1097/dss.0000000000003449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Martha Laurin Council
- Division of Dermatology Department of Internal Medicine Washington University, St. Louis, Missouri
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31
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Liszewski W, Stewart JR, Vidal NY, Demer AM. Incisional Biopsy Technique Is Associated With Decreased Overall Survival for Cutaneous Melanoma. Dermatol Surg 2022; 48:486-491. [PMID: 35298451 DOI: 10.1097/dss.0000000000003430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Previous studies examining melanoma biopsy technique have not demonstrated an effect on overall survival. OBJECTIVE To examine overall survival of patients with cutaneous melanoma diagnosed by shave, punch, incisional, or excisional techniques from the National Cancer Database (NCDB). MATERIALS AND METHODS Melanoma data from the 2004 to 2016 NCDB data set were analyzed. A Cox proportional hazards model was constructed to assess the risk of 5-year all-cause mortality. RESULTS In total, 42,272 cases of melanoma were reviewed, with 27,899 (66%) diagnosed by shave biopsy, 8,823 (20.9%) by punch biopsy, and 5,550 (13.1%) by incisional biopsy. Both the univariate and multivariate analyses demonstrated that tumors diagnosed by incisional biopsy had significantly (p = .001) lower overall 5-year survival compared with shave techniques (hazard ratio [HR] = 1.140, 95% confidence interval [CI] 1.055 to 1.231). We found no difference (p = .109) between shave and punch biopsy techniques (HR 1.062, 95% CI 0.987-1.142) or between punch and incisional techniques (HR 1.074, 95% CI 0.979-1.177, p = .131). CONCLUSION Incisional biopsies were associated with decreased overall 5-year survival in the NCDB. No difference was observed between shave and punch biopsy techniques. These findings support current melanoma management guidelines.
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Affiliation(s)
- Walter Liszewski
- Department of Dermatology, Northwestern University, Chicago, Illinois
- Department of Preventative Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University, Chicago, Illinois
| | - Jacob R Stewart
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Nahid Y Vidal
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Addison M Demer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota
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32
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Jacobsen ES, Soleymani T. Mohs Micrographic Surgery for the Treatment of Cutaneous Melanomas of the Head and Neck. Oral Maxillofac Surg Clin North Am 2022; 34:263-271. [PMID: 35428505 DOI: 10.1016/j.coms.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Surgical excision achieving clear histologic margins remains the mainstay treatment for primary cutaneous melanoma. Tumors of the head and neck, particularly those arising in chronically sun-damaged skin, often demonstrate extensive and asymmetric subclinical extension. Over the decades, this has proven to be a significant problem for tumors arising on the head and neck, as anatomic and functional complexities of these areas have led to suboptimal surgical treatment, yielding unacceptably high rates of local recurrence and persistently positive margins with traditional wide local excision. Patients who undergo Mohs micrographic surgery may have improved survival over those who undergo wide local excision.
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Affiliation(s)
- Emilie S Jacobsen
- Division of Dermatologic Surgery, David Geffen School of Medicine at University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA; Division of Dermatology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Teo Soleymani
- Division of Dermatologic Surgery, David Geffen School of Medicine at University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA; Mohs Micrographic and Reconstructive Surgery, Dermatologic Oncology, Pigmented Lesion and Melanoma Clinic, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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Efendiev KT, Alekseeva PM, Shiryaev AA, Skobeltsin AS, Solonina IL, Fatyanova AS, Reshetov IV, Loschenov VB. Preliminary low-dose photodynamic exposure to the skin cancer with chlorin e6 photosensitizer. Photodiagnosis Photodyn Ther 2022; 38:102894. [PMID: 35490962 DOI: 10.1016/j.pdpdt.2022.102894] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The study was aimed to investigate the chlorin e6 photosensitizer distribution in the tumor and tumor border (5 mm) during low-dose photodynamic treatment and to increase the effectiveness of the therapy for skin neoplasms. METHODS Sensitized boundaries of neoplasms were evaluated by video fluorescence imaging. The study of changes in the chlorin e6 distribution before/after photodynamic therapy and in the process of low-dose photodynamic exposure was carried out by the method of spectral fluorescence diagnostics. RESULTS All 19 patients with basal-cell skin cancer had a contrast of chlorin e6 accumulation compared to normal tissues. 3 hours after intravenous administration of the photosensitizer at a dose of 1 mg/kg, the chlorin e6 concentration was: in normal tissues - 0.18 mg/kg, in the tumor - 1.26 mg/kg, in the tumor border - 0.63 mg/kg. In most cases, the fluorescence indices of chlorin e6 in tumor tissues after low-dose photodynamic therapy increased and exceeded the values before light exposure. CONCLUSION Low-dose photodynamic therapy seems to be the optimal method for treating neoplasms, which does not cause severe pain in patients during the light exposure and allows locally increasing of the photosensitizer concentration in tumor tissues. This method of photodynamic therapy can improve the effectiveness of thе treatment.
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Affiliation(s)
- K T Efendiev
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 119991 Moscow, Russia; National Research Nuclear University "MEPhI", 115409 Moscow, Russia.
| | - P M Alekseeva
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 119991 Moscow, Russia; National Research Nuclear University "MEPhI", 115409 Moscow, Russia
| | - A A Shiryaev
- University Clinical Hospital No. 1, Levshin Institute of Cluster Oncology, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, 119435 Moscow, Russia
| | - A S Skobeltsin
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 119991 Moscow, Russia; National Research Nuclear University "MEPhI", 115409 Moscow, Russia
| | - I L Solonina
- University Clinical Hospital No. 1, Levshin Institute of Cluster Oncology, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, 119435 Moscow, Russia
| | - A S Fatyanova
- University Clinical Hospital No. 1, Levshin Institute of Cluster Oncology, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, 119435 Moscow, Russia
| | - I V Reshetov
- University Clinical Hospital No. 1, Levshin Institute of Cluster Oncology, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, 119435 Moscow, Russia
| | - V B Loschenov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 119991 Moscow, Russia; National Research Nuclear University "MEPhI", 115409 Moscow, Russia
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Thorpe RB, Covington KR, Caruso HG, Quick AP, Zolochevska O, Bricca GM, Campoli M, DeBloom JR, Fazio MJ, Greenhaw BN, Kirkland EB, Machan ML, Brodland DG, Zitelli JA. Development and validation of a nomogram incorporating gene expression profiling and clinical factors for accurate prediction of metastasis in patients with cutaneous melanoma following Mohs micrographic surgery. J Am Acad Dermatol 2022; 86:846-853. [PMID: 34808324 DOI: 10.1016/j.jaad.2021.10.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 09/23/2021] [Accepted: 10/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a need to improve prognostic accuracy for patients with cutaneous melanoma. A 31-gene expression profile (31-GEP) test uses the molecular biology of primary tumors to identify individual patient metastatic risk. OBJECTIVE Develop a nomogram incorporating 31-GEP with relevant clinical factors to improve prognostic accuracy. METHODS In an IRB-approved study, 1124 patients from 9 Mohs micrographic surgery centers were prospectively enrolled, treated with Mohs micrographic surgery, and underwent 31-GEP testing. Data from 684 of those patients with at least 1-year follow-up or a metastatic event were included in nomogram development to predict metastatic risk. RESULTS Logistic regression modeling of 31-GEP results and T stage provided the simplest nomogram with the lowest Bayesian information criteria score. Validation in an archival cohort (n = 901) demonstrated a significant linear correlation between observed and nomogram-predicted risk of metastasis. The resulting nomogram more accurately predicts the risk for cutaneous melanoma metastasis than T stage or 31-GEP alone. LIMITATIONS The patient population is representative of Mohs micrographic surgery centers. Sentinel lymph node biopsy was not performed for most patients and could not be used in the nomogram. CONCLUSIONS Integration of 31-GEP and T stage can gain clinically useful prognostic information from data obtained noninvasively.
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Affiliation(s)
| | | | | | | | | | | | | | - James R DeBloom
- South Carolina Skin Cancer Center, Greenville, South Carolina
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35
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Chiu YJ, Yang JS, Tsai FJ, Chiu HY, Juan YN, Lo YH, Chiang JH. Curcumin suppresses cell proliferation and triggers apoptosis in vemurafenib-resistant melanoma cells by downregulating the EGFR signaling pathway. ENVIRONMENTAL TOXICOLOGY 2022; 37:868-879. [PMID: 34994998 DOI: 10.1002/tox.23450] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/24/2021] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Abstract
Melanoma is a malignant tumor with aggressive behavior. Vemurafenib, a BRAF inhibitor, is clinically used in melanoma, but resistance to melanoma cytotoxic therapies is associated with BRAF mutations. Curcumin can effectively inhibit numerous types of cancers. However, there are no reports regarding the correlation between curcumin and vemurafenib-resistant melanoma cells. In this study, vemurafenib-resistant A375.S2 (A375.S2/VR) cells were established, and the functional mechanism of the epidermal growth factor receptor (EGFR), serine-threonine kinase (AKT), and the extracellular signal-regulated kinase (ERK) signaling induced by curcumin was investigated in A375.S2/VR cells in vitro. Our results indicated that A375.S2/VR cells had a higher IC50 concentration of vemurafenib than the parental A375.S2 cells. Moreover, curcumin reduced the viability and confluence of A375.S2/VR cells. Curcumin triggered apoptosis via reactive oxygen species (ROS) production, disruption of mitochondrial membrane potential (ΔΨm), and intrinsic signaling (caspase-9/-3-dependent) pathways in A375.S2/VR cells. Curcumin-induced apoptosis was also mediated by the EGFR signaling pathway. Combination treatment with curcumin and gefitinib (an EGFR inhibitor) synergistically potentiated the inhibitory effect of cell viability in A375.S2/VR cells. The present study provides new insights into the therapy of vemurafenib-resistant melanoma and suggests that curcumin might be an encouraging therapeutic candidate for its drug-resistant treatment.
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Affiliation(s)
- Yu-Jen Chiu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jai-Sing Yang
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Fuu-Jen Tsai
- Human Genetic Center, China Medical University Hospital, Taichung, Taiwan
- Department of Medical Genetics, China Medical University Hospital, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Hong-Yi Chiu
- Department of Pharmacy, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Graduate Institute of Clinical Pharmacy, College of Medicine, Tzu Chi University, Hualien, Taiwan
- Holistic Education Center, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Yu-Ning Juan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yu-Hsiang Lo
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Jo-Hua Chiang
- Department of Nursing, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
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Newcomer K, Robbins KJ, Perone J, Hinojosa FL, Chen D, Jones S, Kaufman CK, Weiser R, Fields RC, Tyler DS. Malignant melanoma: evolving practice management in an era of increasingly effective systemic therapies. Curr Probl Surg 2022; 59:101030. [PMID: 35033317 PMCID: PMC9798450 DOI: 10.1016/j.cpsurg.2021.101030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/12/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Ken Newcomer
- Department of Surgery, Barnes-Jewish Hospital, Washington University, St. Louis, MO
| | | | - Jennifer Perone
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | | | - David Chen
- e. Department of Medicine, Washington University, St. Louis, MO
| | - Susan Jones
- f. Department of Pediatrics, Washington University, St. Louis, MO
| | | | - Roi Weiser
- University of Texas Medical Branch, Galveston, TX
| | - Ryan C Fields
- Department of Surgery, Washington University, St. Louis, MO
| | - Douglas S Tyler
- Department of Surgery, University of Texas Medical Branch, Galveston, TX.
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Charalambides M, Yannoulias B, Malik N, Mann J, Celebi P, Veitch D, Wernham A. A review of Mohs Micrographic Surgery for skin cancer: Part 1 - melanoma and rare skin cancers. Clin Exp Dermatol 2021; 47:833-849. [PMID: 34939669 DOI: 10.1111/ced.15081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022]
Abstract
Mohs micrographic surgery is a precise and effective method commonly used to treat high risk basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) on the head and neck. Whilst the majority of evidence for Mohs relates to keratinocyte cancers, there is published evidence for other types of skin cancer. This review aims to discuss the evidence for using MMS to treat six different types of skin cancer, including melanoma, lentigo maligna, dermatofibrosarcoma protuberans, atypical fibroxanthoma, microcystic adnexal carcinoma and pleomorphic dermal sarcoma, particularly in the context of survival rates and cancer recurrence. These cancers were chosen as there was sufficient literature for inclusion and given MMS is most useful when cancers are contiguous, rather than for cancers with marked metastatic potential such as angiosarcoma or merkel cell carcinoma. We searched Medline, Pubmed and Embase using the keywords: 'melanoma', 'mohs micrographic surgery', 'lentigo maligna', 'dermatofibrosarcoma protuberans', 'atypical fibroxanthoma', 'microcystic adnexal carcinoma' and 'pleomorphic dermal sarcoma' along with their appropriate synonyms, to identify the relevant English-language articles from the year 2000 onwards given that literature for Mohs on non-keratinocyte is sparse prior to this date. A MeaSurement Tool to Assess systematic Reviews (AMSTAR) was used to assess the validity of systematic reviews. Further high-quality, multi-centre randomised trials are necessary to establish the indications and efficacy of MMS for rarer cancers, particularly for AFX and PDS, where limited studies were identified.
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Affiliation(s)
| | | | - Nabiah Malik
- Watford General Hospital, West Hertfordshire Hospitals NHS trust, UK
| | - Jasmine Mann
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Perin Celebi
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - David Veitch
- Department of Dermatology, Walsall Healthcare NHS Trust, Walsall, UK
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Factors Deterring the Utilization of Mohs Surgery for Treatment of Melanoma: A Nationwide Cross-Sectional Survey of Mohs Surgeons. Dermatol Surg 2021; 47:709-710. [PMID: 33905398 DOI: 10.1097/dss.0000000000002711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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39
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Commentary on Factors Deterring the Utilization of Mohs Surgery for Treatment of Melanoma: A Nationwide Cross-Sectional Survey of Mohs Surgeons. Dermatol Surg 2021; 47:711-712. [PMID: 33625145 DOI: 10.1097/dss.0000000000002743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Cheraghlou S, Christensen SR, Leffell DJ, Girardi M. Association of Treatment Facility Characteristics With Overall Survival After Mohs Micrographic Surgery for T1a-T2a Invasive Melanoma. JAMA Dermatol 2021; 157:531-539. [PMID: 33787836 DOI: 10.1001/jamadermatol.2021.0023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Early-stage melanoma, among the most common cancers in the US, is typically treated with wide local excision. However, recent advances in immunohistochemistry have led to an increasing number of these cases being excised via Mohs micrographic surgery (MMS). Although studies of resections for other cancers have reported that facility-level factors are associated with patient outcomes, it is not yet established how these factors may affect outcomes for patients treated with Mohs micrographic surgery. Objective To evaluate the association of treatment center academic affiliation and case volume with long-term patient survival after MMS for T1a-T2a invasive melanoma. Design, Setting, and Participants In a retrospective cohort study, 4062 adults with nonmetastatic, T1a-T2a melanoma diagnosed from 2004 to 2014 and treated with MMS in the National Cancer Database (NCDB) were identified. The NCDB includes all reportable cases from Commission on Cancer-accredited facilities and is estimated to capture approximately 50% of all incident melanomas in the US. Multivariable survival analyses were conducted using Cox proportional hazards models. Data analysis was conducted from February 27 to August 18, 2020. Exposures Treatment facility characteristics. Main Outcomes and Measures Overall survival. Results The study population included 4062 patients (2213 [54.5%] men; median [SD] age, 60 [16.3] years) treated at 462 centers. Sixty-two centers were top decile-volume facilities (TDVFs), which treated 1757 patients (61.9%). Most TDVFs were academic institutions (37 of 62 [59.7%]). On multivariable analysis, treatment at an academic center was associated with a nearly 30% reduction in hazard of death (hazard ratio, 0.730; 95% CI, 0.596-0.895). In a separate analysis, treatment at TDVFs was also associated with improved survival (hazard ratio, 0.795; 95% CI, 0.648-0.977). Conclusions and Relevance In this cohort study, treatment of patients with T1a-T2a invasive melanoma excised with MMS at academic and top decile-volume (≥8 cases per year) facilities was associated with improved long-term survival compared with those excised by MMS at nonacademic and low-volume facilities. Identification and protocolization of the practices of these facilities may help to reduce survival differences between centers.
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Affiliation(s)
- Shayan Cheraghlou
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Sean R Christensen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - David J Leffell
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
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Yousif R, Boull C, Gerami P, Nardone B, Vivar KL, Liszewski W. THE demographics and trends in pediatric melanoma in the United States: An analysis of the National Cancer Database. Pediatr Dermatol 2021; 38:1191-1197. [PMID: 34250622 DOI: 10.1111/pde.14672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/04/2021] [Accepted: 05/23/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND/OBJECTIVE Relative to adults, rates of melanoma are lower in children. Due to its rarity, it is difficult to assess the incidence, trends, and outcomes of this malignancy. Much of our understanding comes from single institution or regional cancer registries which may not be large enough to detect subtleties in the burden of pediatric melanoma. METHODS Data from the 2004 to 2016 National Cancer Database were analyzed; this database captures approximately 70% of all cancer diagnoses in the United States. RESULTS Our analysis consisted of 1903 cases. A majority were White (89.8%), the mean age was 12.4 years, and the ratio of females: males was 1.2:1.0. The most common anatomic location was the trunk (31.1%). Between 2004 and 2016, a decreasing trend in the number of new melanoma cases was observed. Comparing histologic subtype by age, there was an increased percentage of nodular and epithelioid and spindle cell tumors in the pre-teen children and a greater percentage of superficial spreading tumors in teenagers. Overall, a majority of cases were stage 0 or I (56.9%), with relatively few stage IV cases (2.0%). A 5-year all-cause survival of greater than 90% was observed for stage I-III tumors, with stage IV tumors having a 5-year all-cause survival of 34.4%. CONCLUSION Comparable to previous studies, pediatric melanoma occurred most often in Whites, females, and adolescents. However, we detected a decreasing trend in new cases, noted differences between histologic subtype and age, and observed a 5-year all-cause survival rate of greater than 90% for stage I-III tumors.
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Affiliation(s)
- Rame Yousif
- University of Toledo College of Medicine, Toledo, OH, USA
| | - Christina Boull
- Department of Dermatology, Division of Pediatric Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - Pedram Gerami
- Department of Dermatology, Northwestern University, Chicago, IL, USA.,Division of Dermatopathology, Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - Beatrice Nardone
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - Karina L Vivar
- Department of Dermatology, Northwestern University, Chicago, IL, USA.,Division of Pediatric Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Walter Liszewski
- Department of Dermatology, Northwestern University, Chicago, IL, USA.,Division of Cancer Epidemiology and Prevention, Department of Preventative Medicine, Northwestern University, Chicago, IL, USA
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Theunissen CCW, Lee MH, Murad FG, Waldman AH. Systematic Review of the Role of Mohs Micrographic Surgery in the Management of Early-Stage Melanoma of the Head and Neck. Dermatol Surg 2021; 47:1185-1189. [PMID: 34148999 DOI: 10.1097/dss.0000000000003126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The role of Mohs micrographic surgery (MMS) in the management of melanoma of the head and neck (HNM) has been controversial. The authors systematically reviewed the local recurrence rate of melanoma in situ (MIS) and T1a melanomas using MMS compared with conventional wide local excision (WLE) and staged excision (SE). OBJECTIVE To systematically review the local recurrence rate of early-stage melanomas of the HNM treated with MMS versus WLE or SE. METHODS AND MATERIALS A search of English medical literature was conducted through the common databases until November 26, 2019. Using PRISMA guidelines for the treatment of MIS and T1a melanoma with MMS, WLE, or SE, our search yielded a total of 32 articles. RESULTS Mohs micrographic surgery has a lower local recurrence rate for early-stage melanomas over both SE and WLE {pooled recurrence risk 0.8% (95% confidence interval [CI] 0.4-1.1) versus 2.5% (95% CI 1.5-3.4) versus 8.7% (95% CI 5.1-12.2) (p < .001), respectively}. CONCLUSION Mohs micrographic surgery may offer a lower recurrence rate than SE or WLE in the management of early-stage melanomas of the face or HNM. Further clinical validation in a randomized controlled trial is required.
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Affiliation(s)
| | - Ming Hua Lee
- Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Fadi G Murad
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Abigail H Waldman
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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[Mohs micrographic surgery for skin cancers: A 10 year - single-center series of 548 patients treated by formalin-fixed tissue Mohs surgery assessing the impact of reduced margins]. ANN CHIR PLAST ESTH 2021; 66:429-439. [PMID: 34330553 DOI: 10.1016/j.anplas.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 06/28/2021] [Indexed: 11/22/2022]
Abstract
AIM Only few robust studies specify the indications of Mohs Surgery techniques in skin tumors. The aim of this work was to carry out a review of almost 10 years of experience, assessing the impact of reduced margins on reconstruction, and proposing a management algorithm in the light of the literature. PATIENT AND METHODS All the records of patients having benefited from a Mohs technique in our center were retrospectively compiled from January 2011 until January 2020. A formalin-fixed tissue Mohs surgery was used. An impact assessment of reduced margins was made both on the excisional surface but also on the improvement of the reconstruction. RESULTS 548 patients were included. Complete tumour clearance was achieved with one surgical stage in 71% of cases. The excisional surface of tumours located in the periorbital and nasal areas was significantly more often reduced compared to other areas (P=0,020). The improvement of the reconstruction was deemed significant in the periorbital and nasal areas; as well as for tumours located on limbs and trunk linked with Dermatofibrosarcoma management. CONCLUSION This study underlines the interest of assessing the clinical relevance of reducing margins depending on the tumor location. Our single-center experience feedback on a large series allows to clarify Mohs technique indications by means of a literature review.
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MacArthur KM, Baumann BC, Sobanko JF, Etzkorn JR, Shin TM, Higgins HW, Giordano CN, McMurray SL, Krausz A, Newman JG, Rajasekaran K, Cannady SB, Brody RM, Karakousis GC, Miura JT, Cohen JV, Amaravadi RK, Mitchell TC, Schuchter LM, Miller CJ. Compliance with sentinel lymph node biopsy guidelines for invasive melanomas treated with Mohs micrographic surgery. Cancer 2021; 127:3591-3598. [PMID: 34292585 DOI: 10.1002/cncr.33651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/30/2021] [Accepted: 04/21/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) has not been studied for invasive melanomas treated with Mohs micrographic surgery using frozen-section MART-1 immunohistochemical stains (MMS-IHC). The primary objective of this study was to assess the accuracy and compliance with National Comprehensive Cancer Network (NCCN) guidelines for SLNB in a cohort of patients who had invasive melanoma treated with MMS-IHC. METHODS This retrospective cohort study included all patients who had primary, invasive, cutaneous melanomas treated with MMS-IHC at a single academic center between March 2006 and April 2018. The primary outcomes were the rates of documenting discussion and performing SLNB in patients who were eligible based on NCCN guidelines. Secondary outcomes were the rate of identifying the sentinel lymph node and the percentage of positive lymph nodes. RESULTS In total, 667 primary, invasive, cutaneous melanomas (American Joint Committee on Cancer T1a-T4b) were treated with MMS-IHC. The median patient age was 69 years (range, 25-101 years). Ninety-two percent of tumors were located on specialty sites (head and/or neck, hands and/or feet, pretibial leg). Discussion of SLNB was documented for 162 of 176 (92%) SLNB-eligible patients, including 127 of 127 (100%) who had melanomas with a Breslow depth >1 mm. SLNB was performed in 109 of 176 (62%) SLNB-eligible patients, including 102 of 158 melanomas (65%) that met NCCN criteria to discuss and offer SLNB and 7 of 18 melanomas (39%) that met criteria to discuss and consider SLNB. The sentinel lymph node was successfully identified in 98 of 109 patients (90%) and was positive in 6 of those 98 patients (6%). CONCLUSIONS Combining SLNB and MMS-IHC allows full pathologic staging and confirmation of clear microscopic margins before reconstruction of specialty site invasive melanomas. SLNB can be performed accurately and in compliance with consensus guidelines in patients with melanoma using MMS-IHC.
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Affiliation(s)
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University, St Louis, Missouri
| | - Joseph F Sobanko
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - H William Higgins
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Cerrene N Giordano
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Stacy L McMurray
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Aimee Krausz
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jason G Newman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Steven B Cannady
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Giorgos C Karakousis
- Division of Endocrine and Oncologic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - John T Miura
- Division of Endocrine and Oncologic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Justine V Cohen
- Division of Hematology Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Ravi K Amaravadi
- Division of Hematology Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Tara C Mitchell
- Division of Hematology Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Lynn M Schuchter
- Division of Hematology Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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Soleymani T. Understanding Margins in the Management of Cutaneous Melanoma. The Time for a Paradigm Shift Is Now. Dermatol Surg 2021; 47:827-828. [PMID: 33038105 DOI: 10.1097/dss.0000000000002792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Teo Soleymani
- Zitelli and Brodland Skin Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Cells to Surgery Quiz: June 2021. J Invest Dermatol 2021. [PMID: 34024342 DOI: 10.1016/j.jid.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
BACKGROUND Obtaining conventional wide surgical margins is challenging in melanomas occurring at anatomically complex sites (e.g., hands and feet). OBJECTIVE We investigated the potential benefits of slow Mohs micrographic surgery (MMS) for acral melanomas. MATERIALS AND METHODS This single-center retrospective study investigated 210 patients who underwent slow MMS (n = 66) or wide local excision (WLE, n = 144) for melanomas during 2005 to 2015. Slow MMS was used for melanomas in anatomically complex locations and for high-risk lesions. RESULTS Acral melanoma (166/210) was the most common lesion observed in patients, in addition to head and neck (21/210) and trunk (23/210) melanomas. Slow MMS was more commonly performed for acral, and head and neck melanomas (32.5% and 52.4%, respectively) than for trunk melanomas (4.3%, p = .002). Local recurrence of acral melanomas occurred in 3.7% of patients after slow MMS and in 10.7% of patients after WLE. Multivariate analysis showed comparable prognostic outcomes between slow MMS and WLE used for acral melanomas. Compared with WLE, slow MMS resulted in a smaller postoperative defect after acral lesion excision (p < .001). CONCLUSION Slow MMS is an effective alternative to WLE for acral melanomas in anatomically complex sites, as evidenced by superior outcomes and maximum tissue conservation.
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Jiang J, Liu C, Xu G, Liang T, Yu C, Liao S, Zhang Z, Lu Z, Wang Z, Chen J, Chen T, Li H, Zhan X. Identification of Hub Genes Associated With Melanoma Development by Comprehensive Bioinformatics Analysis. Front Oncol 2021; 11:621430. [PMID: 33912448 PMCID: PMC8072149 DOI: 10.3389/fonc.2021.621430] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/19/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction This study aimed to identify important genes associated with melanoma to further develop new target gene therapies and analyze their significance concerning prognosis. Materials and methods Gene expression data for melanoma and normal tissue were downloaded from three databases. Differentially co-expressed genes were identified by WGCNA and DEGs analysis. These genes were subjected to GO, and KEGG enrichment analysis and construction of the PPI visualized with Cytoscape and screened for the top 10 Hub genes using CytoHubba. We validated the Hub gene's protein levels with an immunohistochemical assay to confirm the accuracy of our analysis. Results A total of 435 differentially co-expressed genes were obtained. Survival curves showed that high expression of FOXM1,\ EXO1, KIF20A, TPX2, and CDC20 in melanoma patients with 5 of the top 10 hub genes was associated with reduced overall survival (OS). Immunohistochemistry showed that all five genes were expressed at higher protein levels in melanoma than in paracancerous tissues. Conclusion FOXM1, EXO1, KIF20A, TPX2, and CDC20 are prognosis-associated core genes of melanoma, and their high expression correlates with the low prognosis of melanoma patients and can be used as biomarkers for melanoma diagnosis, treatment, and prognosis prediction.
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Affiliation(s)
- Jie Jiang
- Spinal Orthopedic Ward, The First Clinical Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chong Liu
- Spinal Orthopedic Ward, The First Clinical Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guoyong Xu
- Spinal Orthopedic Ward, The First Clinical Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tuo Liang
- Spinal Orthopedic Ward, The First Clinical Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chaojie Yu
- Spinal Orthopedic Ward, The First Clinical Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shian Liao
- Spinal Orthopedic Ward, The First Clinical Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zide Zhang
- Spinal Orthopedic Ward, The First Clinical Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhaojun Lu
- Spinal Orthopedic Ward, The First Clinical Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zequn Wang
- Spinal Orthopedic Ward, The First Clinical Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jiarui Chen
- Spinal Orthopedic Ward, The First Clinical Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tianyou Chen
- Spinal Orthopedic Ward, The First Clinical Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hao Li
- Spinal Orthopedic Ward, The First Clinical Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xinli Zhan
- Spinal Orthopedic Ward, The First Clinical Affiliated Hospital of Guangxi Medical University, Nanning, China
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Namin AW, Oudin EM, Tassone PT, Galloway TLI, Dooley LM, Zitsch RP. Treatment of Cutaneous Melanoma of the Head and Neck With Wide Local Excision Versus Mohs. Laryngoscope 2021; 131:2490-2496. [PMID: 33844289 DOI: 10.1002/lary.29570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/25/2021] [Accepted: 04/05/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Determine if Mohs micrographic surgery (MMS) is associated with improved overall survival compared to wide local excision (WLE) when treating cutaneous melanoma of the head and neck (CMHN) and to report the proportion of patients treated with MMS versus WLE who also underwent sentinel lymph node biopsy (SLNB). METHODS Retrospective cohort study of the National Cancer Database (NCDB) analyzing the overall survival of patients diagnosed with T1 to T4 CMHN between 2004 and 2016 who were treated with either WLE or MMS. RESULTS On multivariable analysis, treatment with WLE versus MMS was not significantly associated with overall survival (HR, 1.094; 95% CI, 0.997-1.201). On multivariable analysis, lower Charlson-Deyo score (HR, 0.489; 95% CI, 0.427-0.560), negative margins (HR, 0.754; 95% CI, 0.705-0.807), and N0 classification (HR 0.698; 95% CI, 0.668-0.730) were associated with improved overall survival. Seventy-seven percent of patients treated with MMS did not undergo SLNB, while 45% of patients treated with WLE did not undergo SLNB (P < .001). CONCLUSIONS No difference in overall survival between MMS and WLE when treating CMHN. Patients treated with MMS were significantly less likely to undergo SLNB, suggesting an opportunity for enhancement of multidisciplinary care. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Arya W Namin
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Edouard M Oudin
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Patrick T Tassone
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Tabitha L I Galloway
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Laura M Dooley
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Robert P Zitsch
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
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Demer AM, Hanson JL, Maher IA, Liszewski W. Association of Mohs Micrographic Surgery vs Wide Local Excision With Overall Survival Outcomes for Patients With Melanoma of the Trunk and Extremities. JAMA Dermatol 2021; 157:84-89. [PMID: 33084853 DOI: 10.1001/jamadermatol.2020.3950] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Although previous database studies suggest that Mohs micrographic surgery (MMS) treatment is associated with improved overall survival (OS) for head and neck melanomas, outcomes for trunk and extremity (T&E) tumors have not been adequately evaluated. Objective To assess survival outcomes for patients with melanomas of the T&E treated with MMS vs wide local excision (WLE). Design, Setting, and Participants This retrospective cohort study examined deidentified data from the National Cancer Database between 2004 and 2015. Inclusion criteria for the analysis included diagnosis of trunk, upper extremity, or lower extremity melanoma; known Breslow depth; removal by MMS or WLE; and known last date of survival status. Main Outcomes and Measures Five-year all-cause mortality (ACM) rates. Results A total of 188 862 in situ and invasive melanomas were included in the analysis (MMS, 2.3%; WLE, 97.7%); the mean (SD) age of patients included was 58.8 (16.0) years, and 52.7% were male. Multivariate analysis demonstrated no OS difference among trunk (WLE hazard ratio [HR], 1.097; 95% CI, 0.950-1.267; P = .21), upper extremity (WLE HR, 1.013; 95% CI, 0.872-1.176; P = .87), lower extremity (WLE HR, 0.934; 95% CI, 0.770-1.134; P = .49), or combined T&E (WLE HR, 1.031; 95% CI, 0.941-1.130; P = .51) tumors. Factors associated with increased risk of ACM on multivariate analysis of all tumors included increasing age (HR, 1.043; 95% CI, 1.042-1.044; P < .001), no insurance or nonprivate insurance (none: HR, 1.921 [95% CI, 1.782-2.071]; Medicaid: HR, 2.410 [95% CI, 2.242-2.591]; Medicare: HR, 1.237 [95% CI, 1.194-1.281]; other government insurance: HR, 1.279 [95% CI, 1.117-1.465]; P < .001 for all), positive surgical margins (HR, 1.609; 95% CI, 1.512-1.712; P < .001), a Charlson-Deyo comorbidity score greater than 0 (Charlson-Deyo score of 1: HR, 1.340; 95% CI, 1.295-1.385; P < .001; Charlson-Deyo score of ≥2: HR, 2.044; 95% CI, 1.934-2.159; P < .001), tumor ulceration (HR, 2.175; 95% CI, 2.114-2.238; P < .001), and increasing Breslow depth (HR, 1.002 [per 0.1 mm]; P < .001). Female sex (HR, 0.698; 95% CI, 0.680-0.716; P < .001) and nonnodular subtype (lentigo maligna/lentigo maligna melanoma: HR, 0.743; 95% CI, 0.686-0.805; P < .001; superficial spreading: HR, 0.739; 95% CI, 0.710-0.769; P < .001; other subtype: HR, 0.817; 95% CI, 0.790-0.845; P < .001; nodular: HR, 1 [reference]) were associated with improved OS. Conclusions and Relevance This cohort study of patients surgically treated for melanomas of the trunk and/or extremities found that, compared with WLE, MMS was not associated with significantly different OS for T&E melanomas.
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Affiliation(s)
- Addison M Demer
- Department of Dermatology, University of Minnesota, Minneapolis.,Now with Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Jamie L Hanson
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Walter Liszewski
- Department of Dermatology, Northwestern University, Chicago, Illinois
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