Margin Involvement after the Excision of Melanoma In Situ: The Need for Complete En Face Examination of the Surgical Margins

• Published in: Dermatologic surgery Vol. 33; no. 12; pp. 1434 - 1441
• Main Authors: KIMYAI‐ASADI, ARASH, KATZ, TRACY, GOLDBERG, LEONARD H., AYALA, GABRIEL B., WANG, STEVEN Q., VUJEVICH, JUSTIN J., JIH, MING H.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.12.2007
• ISSN: 1076-0512; 1524-4725
• DOI: 10.1111/j.1524-4725.2007.33313.x

BACKGROUND The standard treatment for cutaneous melanoma in situ is surgical excision followed by standard pathologic evaluation. Serial cross‐sectioning (bread‐loafing) may result in false negative margin examination and higher local recurrence rates than Mohs micrographic surgery, which histologically evaluates the entire surgical margin. OBJECTIVE To estimate the sensitivity of bread‐loafing in detecting residual melanoma in situ at surgical margins. METHODS A retrospective study was performed including 36 cases of melanoma in situ treated with Mohs surgery with positive margins after initial excision with 5 mm margins. The length of the margin involved with melanoma was measured. The ability of bread‐loafing to detect residual tumor was calculated. RESULTS The average linear extent of tumor at the surgical margin was 1.4 mm. Bread‐loafing at 1, 2, 4, and 10 mm intervals would have a 58, 37, 19, and 7% chance of detecting positive margins, respectively. In order to detect 100% of positive margins, bread‐loafing would have to be performed every 0.1 mm. CONCLUSION Bread‐loaf cross‐sections through excised melanoma specimens are inherently unreliable for detecting residual melanoma at the surgical margins. We recommend complete histologic margin control of the entire surgical margin using en‐face tissue orientation (Mohs technique) to reduce the risk of recurrence.