Positive Margins in Cutaneous Melanoma of the Head and Neck: Implications for Timing of Reconstruction

2020 ◽  
pp. 019459982096917
Author(s):  
Arya W. Namin ◽  
Lauren Welby ◽  
Austin T. Baker ◽  
Laura M. Dooley
Keyword(s):  
Surgical Treatment ◽  
Head And Neck ◽  
Cutaneous Melanoma ◽  
Spindle Cell ◽  
National Cancer Database ◽  
Clinicopathologic Features ◽  
Lentigo Maligna ◽  
Positive Margins ◽  
Lentigo Maligna Melanoma ◽  
The Face

Objective The aim of this study is to identify clinicopathologic features associated with positive margins after surgical treatment of cutaneous melanoma of the head and neck (CMHN). Study Design Retrospective cohort study. Setting National Cancer Database. Methods A retrospective analysis of the National Cancer Database was performed of patients diagnosed with CMHN between 2004 and 2016. Univariate and multivariate analyses examining the association of clinicopathologic features with positive margins were performed via logistic regression analysis. Results A total of 101,560 patients met inclusion criteria. The incidence of positive margins was 5.0% (5128/101,560). Patients were significantly more likely to have positive margins with the following: increasing age ( P < .001; odds ratio [OR], 1.028; 95% CI, 1.026-1.031), the lip subsite ( P < .001; OR, 1.664; 95% CI, 1.286-2.154), the eyelid subsite ( P < .001; OR, 2.380; 95% CI, 1.996-2.838), the face subsite ( P < .001; OR, 1.215; 95% CI, 1.133-1.302), the lentigo maligna/lentigo maligna melanoma subtype ( P = .019; OR, 1.099; 95% CI, 1.016-1.188), the desmoplastic subtype ( P < .001; OR, 1.455; 95% CI, 1.261-1.680), the spindle cell subtype ( P = .006; OR, 1.276; 95% CI, 1.073-1.516), and advanced pT classification. Patients with male sex ( P < .001; OR, 0.733; 95% CI, 0.687-0.782) and without ulceration ( P < .001; OR, 0.803; 95% CI, 0.736-0.876) were significantly less likely to have positive margins. Conclusion The following have been identified as clinicopathologic features associated with positive margins after surgical treatment of CMHN: increasing age, female sex, the lip subsite, the eyelid subsite, the face subsite, ulceration, the lentigo maligna/lentigo maligna melanoma subtype, the desmoplastic subtype, the spindle cell subtype, and increasing pT classification.

Considerations for Timing of Defect Reconstruction in Cutaneous Melanoma of the Head and Neck

2019 ◽  
Vol 35 (04) ◽  
pp. 404-409 ◽  
Author(s):  
Arya W. Namin ◽  
Georgeanne E. Cornell ◽  
Emily H. Smith ◽  
Robert P. Zitsch
Keyword(s):  
Head And Neck ◽  
Local Excision ◽  
Cutaneous Melanoma ◽  
Wide Local Excision ◽  
Tumor Thickness ◽  
Margin Status ◽  
Lentigo Maligna ◽  
Positive Margins ◽  
Lentigo Maligna Melanoma ◽  
Delayed Reconstruction

AbstractThe objective of this study is to identify the incidence and characteristics of cases with positive margins on wide local excision for cutaneous melanoma of the head and neck (CMHN) and therefore provide a potential basis for selectively delaying reconstruction pending final histological clearance of melanoma. A systematic review of English language articles was performed on studies retrieved from PubMed and Web of Science. Original investigations published between July 1999 and June 2018 reporting on margin status of CMHN wide local excision specimens were included in the review. The incidence of positive margins after definitive resection for cutaneous melanoma in the literature ranges from 6 to 20.9%. The incidence is higher in cases of advanced patient age, diagnosis by shave biopsy, lentigo maligna melanoma subtype, desmoplastic subtype, tumor thickness, and ulceration. Delayed reconstruction remains the most oncologically sound decision, allowing for interpretation of margin status on paraffin-embedded tissue sections. However, resection and the resultant defect closure in a single stage is more expedient and potentially a more efficient use of resources. The risk–benefit ratio of immediate versus delayed reconstruction must be considered for each case. The incidence of positive margins is higher in cases of advanced patient age, diagnosis by shave biopsy, lentigo maligna melanoma subtype, desmoplastic subtype, increasing tumor thickness, and the presence of ulceration; delayed reconstruction should be strongly considered in these cases.

Clinicopathologic features and outcome of head and neck mucosal spindle cell squamous cell carcinoma

2021 ◽  
Author(s):  
Carlos N. Prieto-Granada ◽  
Bin Xu ◽  
Bayan Alzumaili ◽  
Mohamed Rizwan Haroon Al Rasheed ◽  
Antoine Eskander ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Spindle Cell ◽  
Clinicopathologic Features

The Perimeter Technique in the Surgical Treatment of Lentigo Maligna and Lentigo Maligna Melanoma

2012 ◽  
Vol 103 (8) ◽  
pp. 748-750
Author(s):  
B. García Bracamonte ◽  
S.I. Palencia-Pérez ◽  
G. Petiti ◽  
F. Vanaclocha-Sebastián
Keyword(s):  
Surgical Treatment ◽  
Lentigo Maligna ◽  
Lentigo Maligna Melanoma

scholarly journals Lentigo Maligna Melanoma of the Head and Neck

1993 ◽  
Vol 103 (5) ◽  
pp. 520???524 ◽  
Author(s):  
F. P. Johns Langford ◽  
Samuel R. Fisher ◽  
David W. Molter ◽  
Hilliard F. Seigler
Keyword(s):  
Head And Neck ◽  
Lentigo Maligna ◽  
Lentigo Maligna Melanoma

scholarly journals SURGICAL TREATMENT OF HEAD AND NECK CUTANEOUS MELANOMA: A MODERN APPROACH TO THE PROBLEM

2016 ◽  
Vol 6 (4) ◽  
pp. 19-25
Author(s):  
M. B. Pak ◽  
A. M. Mudunov ◽  
L. V. Demidov ◽  
R. I. Azizyan ◽  
V. Zh. Brzhezovskiy ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Head And Neck ◽  
Cutaneous Melanoma ◽  
Modern Approach

scholarly journals Primary Malignant Melanoma of Maxilla: Report of a Case with Discussion

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
G. Shirisha Rani ◽  
T. Vinay Kumar ◽  
Balaram Kolasani ◽  
Md Rezwana Begum ◽  
Anu Priya Srinivasan
Keyword(s):  
Surgical Treatment ◽  
Malignant Melanoma ◽  
Oral Cavity ◽  
Head And Neck ◽  
Cutaneous Melanoma ◽  
Dental Clinic ◽  
Oral Melanoma ◽  
Pigmented Lesion ◽  
Oral Malignant Melanoma ◽  
Rule Out

Primary oral malignant melanoma, very rare neoplasm of melanocytic origin, usually presents as a bluish black to tan-brown colored lesion Which is accounting for 0.2 to 8% of all melanomas, 1.6% of all head and neck malignancies, and 0.5% of all oral neoplasia. In general, the prognosis of oral melanoma is poor and worse than that of cutaneous melanoma. Here a case of oral malignant melanoma is presented, which was undetected during the first visit to a dental clinic. When a simple oral surgical treatment was carried out in that region, it resulted in the appearance of a massive pigmented lesion which was histopathologically diagnosed as malignant melanoma. This paper is presented to reemphasize the fact that any pigmented lesion in the oral cavity should be viewed with suspicion and proper investigation (biopsy) should be carried out to rule out any untoward experiences later.

scholarly journals Subtyping Cutaneous Melanoma Matters

2020 ◽  
Vol 4 (6) ◽  
Author(s):  
Mary-Ann El Sharouni ◽  
Paul Johannes van Diest ◽  
Arjen Joost Witkamp ◽  
Vigfús Sigurdsson ◽  
Carla Henrica van Gils
Keyword(s):  
Survival Data ◽  
Cutaneous Melanoma ◽  
Hazard Ratio ◽  
Breslow Thickness ◽  
Lentigo Maligna ◽  
Acral Lentiginous Melanoma ◽  
Netherlands Cancer Registry ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Lentigo Maligna Melanoma

Abstract Background Our aim was to investigate the role of melanoma subtype on survival and focus on the effects stratified by Breslow thickness and ulceration status. Methods Patients with cutaneous melanoma stage I, II, or III diagnosed between 2000 and 2014 were derived from the Dutch Nationwide Pathology Registry and overall survival data from the Netherlands Cancer Registry. Patients were followed until 2018. Using multivariable Cox proportional hazards models, hazard ratios were calculated for each melanoma subtype, per Breslow thickness category and ulceration status, and adjusted for age, sex, stage, and localization. Results A total of 48 361 patients were included: 79.3% had superficial spreading melanoma (SSM), 14.6% nodular melanoma (NM), 5.2% lentigo maligna melanoma, and 0.9% acral lentiginous melanoma (ALM). In the total patient group, using SSM as the reference category, adjusted hazard ratios were 1.06 (95% confidence interval [CI] = 1.01 to 1.12) for NM, 1.02 (95% CI = 0.93 to 1.13) for lentigo maligna melanoma, and 1.26 (95% = CI 1.06 to 1.50) for ALM. Among patients with 1.0 mm or less Breslow thickness and no ulceration, NM showed a twofold increased risk (hazard ratio = 1.96, 95% CI = 1.58 to 2.45) compared with SSM. Compared with 1.0 mm or less SSM without ulceration, the hazard ratio for 1.0 mm or less SSM with ulceration was 1.94 (95% CI = 1.55 to 2.44), and the hazard ratio for 1.0 mm or less NM with ulceration was 3.46 (95% CI = 2.17 to 5.50). NM patients with tumors greater than 1.0 mm did not show worse survival than SSM patients with tumors greater than 1.0 mm. Conclusions In this large nationwide study, ALM patients showed worse survival than SSM patients. Among patients with melanomas that were thin (1.0 mm or less), NM subtype patients also showed worse survival than SSM patients.

Sign in / Sign up

Export Citation Format

Share Document