Melanoma: Staged Excision Recommended in Sun-damaged Skin

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Staged excision reduces the likelihood of recurrence of melanoma among patients with chronically sun-damaged skin.
Staged excision reduces the likelihood of recurrence of melanoma among patients with chronically sun-damaged skin.

Staged excision reduces the likelihood of recurrence of melanoma among patients with chronically sun-damaged skin, according to an article published in JAMA Dermatology.1

Melanoma on the head or neck of patients with sun-damaged skin often has poorly defined margins, and is consequently more likely to recur after excision with standard margins than disease on the trunk and extremities. For this study, researchers evaluated whether staged excision reduces the likelihood of disease recurrence.

The authors obtained data of 806 patients using the University of Michigan Melanoma Database; virtually all patients were Caucasian, with the exception of 1 Hispanic/Latino patient. Follow-up after staged excision was at 5 years, 7.5 years, and 10 years.

Of 834 staged excision procedures, there were 17 recurrences after 10 years; at 5, 7.5, and 10 years, the recurrence rates were 1.4%, 1.8%, and 2.2%, respectively. The risk of recurrence lowered with each stage of excision: there were 8 recurrences among patients who underwent only 1 excision, while there were no recurrences among those who underwent more than 3.

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A periocular tumor site had a higher risk of recurrence, which occurred among 7 of 62 patients; 15 of the 17 recurrences occurred among those with lentigo maligna.

The authors concluded that the staged excision method led to a high rate of disease control and patient satisfaction.

Reference

  1. Moyer JS, Rudy S, Boonstra PS, et al. Efficacy of staged excision with permanent section margin control for cutaneous head and neck melanoma. JAMA Dermatol. 2016 Dec 21. doi: 10.1001/jamadermatol.2016.4603 [Epub ahead of print]
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