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A method for distinguishing the intended margins for a melanoma from the tissue cones after surgical excision
David Kriegel1, Ellen Marmur, Hui Yi Shan
1Department of Dermatology, Mount Sinai Medical Center, New York, NY, USA.
Background:
Surgical excision of severely dysplastic nevi and thin cutaneous melanomas (<1 mm in depth) remains the most effective treatment to date. However, sometimes a severely dysplastic nevus may be upstaged to a melanoma in situ, or a melanoma in situ may be upgraded to an invasive melanoma once the completely excised specimen is reviewed microscopically. This then requires a re-excision around the entire scar at follow-up as the dermatological surgeon can be perplexed as to where the precise locations of the pigmented lesion and the tissue cones are, thereby generating a longer scar.
Objective:
We want to introduce a simple, cost-effective and easy-to-implement approach that permits the dermatological surgeon to distinguish from a linear scar the site of the original pigmented lesion and the lengths of the tissue cones. Therefore, if a re-excision is necessary, instead of surgical removal around the entire scar, only a focal directed excision of the pigmented lesion is necessary and this will result in a shorter scar; this will be useful for cosmetically sensitive areas on the face. A case is included to illustrate our objective.
Results And Discussion:
Using our surgical method on a patient's left cheek pigmented lesion originally diagnosed as melanoma in situ with a subsequent revised diagnosis of invasive melanoma generated a shorter scar and a favorable cosmetic outcome.
Insights
A new surgical technique helps dermatologists precisely locate pigmented lesions for re-excision, reducing scar length. This method ensures shorter scars, especially in cosmetically sensitive facial areas, improving patient outcomes.
Area of Science:
- Dermatology
- Surgical Oncology
- Pathology
Background:
- Surgical excision is standard for dysplastic nevi and thin melanomas.
- Microscopic review can lead to re-staging, necessitating re-excision.
- Identifying original lesion sites after excision can be challenging, leading to longer scars.
Observation:
- A novel, cost-effective surgical approach is introduced.
- This method allows clear identification of the original pigmented lesion site and tissue cone margins.
- It simplifies the process for dermatological surgeons performing re-excisions.
Findings:
- The described surgical technique facilitates precise, directed re-excision.
- This approach results in significantly shorter scars compared to traditional methods.
- A case study demonstrated a favorable cosmetic outcome on the patient's cheek.
Implications:
- Reduces the need for extensive re-excision, minimizing scarring.
- Offers improved cosmetic results, particularly for facial lesions.
- Provides a practical solution for dermatological surgeons managing pigmented lesions requiring re-excision.
