■在过去的几十年中,原位黑色素瘤(MIS)的发病率显着增加,传统的MIS治疗指南是临床切缘为5毫米的切除;然而,当前的澳大利亚和其他指南现在建议5到10毫米的边距。这一改变的建议主要是由使用Mohs显微手术的研究结果驱动的。最近使用Mohs显微手术的研究提倡甚至更广泛的切除高达18毫米的间隙。
■评估5毫米边缘切除的MIS的复发率。
■该病例系列研究了2011年1月1日至2018年11月30日之间来自单个私人皮肤科诊所的所有MIS病变。纳入标准是手术报告上记录的5毫米切除边缘,以及广泛的局部切除后5年以上的特定地点随访。如果切除边缘超过5毫米或没有记录,则排除病变。随访时间不到5年,或者他们需要超过1个广泛的局部切除。数据分析于2024年1月30日至2月25日进行。
■宽局部切除,边缘5毫米。
■从292名患者中确定了351例MIS(平均[SD]年龄,60.3[11.8]岁;162名女性[55.5%])。浅表扩散黑色素瘤是最常见的诊断亚型(177个病灶[50.4%]),其次是扁豆恶性肿瘤(107个病灶[30.5%])和扁豆MIS(67个病灶[19.1%])。躯干是最常见的病变位置(168个病变[47.9%]),其次是上肢(96个病灶[27.4%])和下肢(59个病灶[16.8%])。头皮是最不常见的位置(2个病变[0.6%])。大多数病变很小,其中274个病变(78.1%)的长度小于10毫米,312个病变(88.9%)的宽度小于10毫米。按照现行指南,切除后的临床切缘为5毫米,共348个病变(99.1%)没有临床复发。共有3个病灶(0.9%)出现局部复发,无转移扩散。
■该病例系列发现,在低风险的身体部位,对于较小尺寸(<10毫米)的MIS,切除5毫米的边缘具有较低的复发率。保守的5毫米切除边缘可能适合低风险身体部位的小型MIS。
UNASSIGNED: The incidence of melanoma in situ (MIS) has increased significantly over the past decades, and traditional guidelines for treatment of MIS have been excision with a 5-mm clinical margin; however, current Australian and other guidelines now recommend 5- to 10-mm margins. This changed recommendation was largely driven by the outcomes of studies using Mohs micrographic surgery, and recent studies using Mohs micrographic surgery are advocating for even wider excisions up to 18 mm for clearance.
UNASSIGNED: To assess the rate of recurrence of MIS excised with a 5-mm margin.
UNASSIGNED: This case series studied all MIS lesions from a single private dermatology clinic between January 1, 2011, and November 30, 2018. The criteria for inclusion were a documented 5-mm excisional margin on operation report and more than 5 years of site-specific follow-up after wide local excision. Lesions were excluded if the excisional margin was more than 5 mm or undocumented, there was less than 5 years of follow-up, or they required more than 1 wide local excision. Data analysis was performed January 30 to February 25, 2024.
UNASSIGNED: Wide local excision with 5-mm margin.
UNASSIGNED: A total of 351 MISs were identified from 292 patients (mean [SD] age, 60.3 [11.8] years; 162 females [55.5%]). Superficial spreading melanoma was the most common subtype diagnosed (177 lesions [50.4%]), followed by lentigo maligna (107 lesions [30.5%]) and lentiginous MIS (67 lesions [19.1%]). The trunk was the most common location of lesions (168 lesions [47.9%]), followed by upper limb (96 lesions [27.4%]) and lower limb (59 lesions [16.8%]). Scalp was the least common location (2 lesions [0.6%]). Most of the lesions were small, with 274 lesions (78.1%) having a length less than 10 mm and 312 lesions (88.9%) having a width less than 10 mm. A total of 348 lesions (99.1%) did not have clinical recurrence after excision with a 5-mm clinical margin following then current guidelines. A total of 3 lesions (0.9%) experienced local recurrence with no metastatic spread.
UNASSIGNED: This case series found that excision with a 5-mm margin for MIS of smaller size (<10 mm) on low-risk body sites had a low rate of recurrence. Conservative 5-mm excisional margin is likely to be suitable for small MIS on lower-risk body sites.