Clinical and pathologic factors associated with subclinical spread of invasive melanoma

• Published in: Journal of the American Academy of Dermatology Vol. 76; no. 4; pp. 714 - 721
• Main Authors: Shin, Thuzar M., Shaikh, Waqas R., Etzkorn, Jeremy R., Sobanko, Joseph F., Margolis, David J., Gelfand, Joel M., Chu, Emily Y., Elenitsas, Rosalie, Miller, Christopher J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017
• Subjects: Adult; Age Factors; Aged; appropriate use criteria; Cross-Sectional Studies; Dermatology; excision; Female; Head and Neck Neoplasms - immunology; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - surgery; Humans; Hutchinson's Melanotic Freckle - immunology; Hutchinson's Melanotic Freckle - pathology; Hutchinson's Melanotic Freckle - surgery; Immunocompetence; invasive melanoma; Male; MART-1 Antigen - analysis; MART-1 Antigen - immunology; Melanoma - immunology; Melanoma - pathology; Melanoma - surgery; Melanoma, Cutaneous Malignant; Middle Aged; Mitotic Index; Mohs micrographic surgery; Mohs Surgery; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - prevention & control; Neoplasm, Residual; Plastic Surgery Procedures; Retrospective Studies; Risk Factors; Skin Neoplasms - immunology; Skin Neoplasms - pathology; Skin Neoplasms - surgery; subclinical spread; T-Lymphocytes - immunology; excision; OR; NCCN; subclinical spread; MART-1; CI; ROC; SLNB; appropriate use criteria; Mohs micrographic surgery; WLE; MMS; invasive melanoma; AJCC; sentinel lymph node biopsy; wide local excision; odds ratio; American Joint Committee on Cancer; confidence interval; National Comprehensive Cancer Network; melanoma antigen recognized by T cells 1; receiver operating characteristic
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2016.11.048

Indications to treat invasive melanoma with Mohs micrographic surgery (MMS) or analogous techniques with exhaustive microscopic margin assessment have not been defined. Identify clinical and histologic factors associated with subclinical spread of invasive melanoma. This retrospective, cross-sectional study evaluated 216 invasive melanomas treated with MMS and melanoma antigen recognized by T cells 1 immunostaining. Logistic regression models were used to correlate clinicopathologic risk factors with subclinical spread and construct a count prediction model. Risk factors associated with subclinical spread by multivariate analysis included tumor localization on the head and neck (OR 3.28, 95% confidence interval [CI] 1.16-9.32), history of previous treatment (OR 4.18, 95% CI 1.42-12.32), age ≥65 (OR 4.45, 95% CI 1.29-15.39), and ≥1 mitoses/mm2 (OR 2.63, 95% CI 1.01-6.83). Tumor thickness and histologic subtype were not associated with subclinical spread. The probability of subclinical spread increased per number of risk factors, ranging from 9.22% (95% CI 2.57%-15.86%) with 1 factor to 80.32% (95% CI 68.13%-92.51%) with 5 factors. This study was conducted at a single academic institution with a small study population using a retrospective study design that was subject to potential referral bias. Clinical and histologic factors identify invasive melanomas that are at increased risk for subclinical spread and might benefit from MMS or analogous techniques prior to reconstruction.