This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on Web of Science (10)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Dermatologic Disorders  • Neoplasms  • Dermatologic Procedures  • Dermatologic Surgery  • Alert me on articles by topic  Social Bookmarking   What's this?

The Technique of Mapped Serial Excision

Shyamala C. Huilgol, FACD; Dinesh Selva, FRANZCO; Celia Chen, MBBS; Dudley C. Hill, FACD; Craig L. James, FRCPA; Amanda Gramp, FRCPA; Raman Malhotra, FRCOphth

Arch Dermatol. 2004;140:1087-1092.

Objectives  To assess the margins required for excision of lentigo maligna (LM) and lentigo maligna melanoma (LMM) by the technique of mapped serial excision (MSE), and to assess the efficacy of MSE.

Design  An interventional, prospective, noncontrolled case series.

Setting  Tertiary referral, dermatologic surgery unit.

Patients  Consecutive patients with head and neck LM or LMM who underwent MSE between March 1, 1993, and October 31, 2002.

Intervention  The MSE of LM or LMM.

Main Outcome Measures  The number of 5-mm levels for excision of LM and LMM and recurrence.

Results  One hundred sixty-one LMs or LMMs in 155 patients were treated. Thirty percent (37 of 125) of LMs required more than 5-mm margins. For LMMs less than 1 mm in Breslow thickness, 12% (4/32) required more than 10-mm margins. For primary tumors, 20% of LMs (18 of 91) required more than 5-mm margins, while 10% of LMMs less than 1 mm in Breslow thickness (2 of 21) required more than a 10-mm margin. For recurrent tumors, 56% of LMs (19/34) required more than a 5-mm margin. Mean follow-up of 38 months (range, 5-100 months) showed 4 recurrences (2%) after MSE. The extrapolated recurrence at 5 years was 5.0%.

Conclusions  The current recommendations of 5-mm margins for LM and 10-mm margins for LMM less than 1 mm in Breslow thickness are often insufficient. Our results demonstrate the importance of margin-controlled excision, particularly in recurrent lesions. The use of MSE offers a high cure rate, in conjunction with tissue conservation.

From the Department of Dermatology (Drs Huilgol and Hill) and Oculoplastic and Orbital Unit, Department of Ophthalmology (Drs Selva, Chen, and Malhotra), Royal Adelaide Hospital, University of Adelaide; Adelaide Pathology Partners (Dr James), Gramp Skin Pathology (Dr Gramp), and Hill Day Surgery, Wakefield Clinic (Drs Huilgol and Hill), Adelaide, Australia. The authors have no relevant financial interest in this article.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?