Frequency of residual melanoma in wide local excision (WLE) specimens after complete excisional biopsy

• Published in: Journal of the American Academy of Dermatology Vol. 74; no. 1; pp. 102 - 107
• Main Authors: Bolshinsky, Vladimir, MBBS, DipSurgAnat, FRACS, Lin, Matthew J., MBBS (Hons), BMedSc, Serpell, Jonathan, MBBS, MD, MEd, FRACS, FACS, Leung, Michael, MBBS, FRACS, Wolfe, Rory, BSc, PhD, McLean, Catriona, MD, FRCPA, Kelly, John W., MD, FACD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2016
• Subjects: Adult; Aged; Analysis of Variance; Australia; Biopsy - methods; Cohort Studies; complete excisional biopsy; Confidence Intervals; cutaneous melanoma; Dermatology; Female; Humans; Immunohistochemistry; lentigo maligna; lentigo maligna melanoma; Lymph Nodes - pathology; Male; Melanoma - mortality; Melanoma - pathology; Melanoma - surgery; Middle Aged; Neoplasm Invasiveness - pathology; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Neoplasm, Residual - mortality; Neoplasm, Residual - pathology; nodular melanoma; Prognosis; residual disease; residual melanoma; Retrospective Studies; Risk Assessment; Skin Neoplasms - mortality; Skin Neoplasms - pathology; Skin Neoplasms - surgery; superficial spreading melanoma; Survival Rate; Treatment Outcome; wide local excision; Australia; cutaneous melanoma; LM; lentigo maligna; wide local excision; OR; lentigo maligna melanoma; residual disease; CI; residual melanoma; nodular melanoma; IQR; interquartile range; odds ratio; SSM; LMM; WLE; complete excisional biopsy; confidence interval; superficial spreading melanoma
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2015.08.065

Objective We sought to better understand the role of wide local excision (WLE) in the treatment of cutaneous melanoma by analyzing residual or locally metastatic disease in WLE specimens of melanomas initially diagnosed with a complete excisional biopsy. Methods This was a retrospective review of 807 consecutive WLEs of melanomas diagnosed after complete excisional biopsy. All specimens were reviewed by a single dermatopathologist. Risk of residual or locally metastatic disease was analyzed using univariate and multivariate logistic regression models. Results In the 807 WLE specimens, further melanoma was found in 34 cases (4.2%; 95% confidence interval [CI] 2.9-5.8). Residual primary melanoma was found in 33 of these. On univariate analysis, features associated with residual or locally metastatic disease were histologic subtype (odds ratio 3.0; 95% CI 1.3-7.1, P  = .01) and tumor location (odds ratio 7.3; 95% CI 2.0-26.6, P  < .01). On multivariate analysis, lentigo maligna was independently associated with melanoma remaining in WLE specimens (odds ratio 2.7; 95% CI 1.0-7.3, P  = .04). Conclusion Residual melanoma in WLE specimens after histologically assessed complete excisional biopsy is not uncommon. Patients with lentigo maligna subtype melanomas are most at risk. Our findings indicate that the procedure of WLE is most important therapeutically for its role in controlling the primary tumor, rather than in preventing local metastatic recurrence.