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Risk Factors Predicting Positive Margins at Primary Wide Local Excision of Cutaneous Melanoma
Aaron R Mangold1, Ryan Skinner, Amylou C Dueck
1*Department of Dermatology, Mayo Clinic, Scottsdale, Arizona; †Division of Dermatology, LewisGale Hospital Montgomery, Blacksburg, Virginia; ‡Section of Biostatistics, Mayo Clinic, Scottsdale, Arizona; §Department of Surgery, Section of Surgical Oncology, Mayo Clinic, Phoenix, Arizona.
Positive margins after wide local excision (WLE) for cutaneous melanoma (CM) are uncommon but linked to older age, thicker tumors, and head/neck location. Achieving clear margins is crucial to reduce local recurrence risk.
Area of Science:
- Dermatology
- Surgical Oncology
- Pathology
Background:
- Positive histological margins after wide local excision (WLE) for cutaneous melanoma (CM) occur in a small percentage of patients.
- Identifying risk factors for positive margins after WLE is crucial for effective treatment planning.
Purpose of the Study:
- To identify clinical and pathological risk factors associated with positive margins following WLE of CM.
- To evaluate the impact of positive margins on local recurrence rates.
Main Methods:
- Retrospective review of patients with CM treated with WLE and sentinel lymph node biopsy (1997-2011).
- Analysis of patient demographics, tumor characteristics, and margin status.
- Comparison of local recurrence rates between patients with positive and negative margins.
Main Results:
- Positive margins were found in 6% of patients undergoing WLE for CM.
- Risk factors for positive margins included older age (≥72.4 years), thicker tumors (≥3.6 mm), head and neck location, positive initial biopsy margins, and presence of melanoma in situ.
- Patients with positive margins had a significantly higher 5-year local recurrence rate (16.0% vs 6.9%).
Conclusions:
- Positive margins after WLE for CM are infrequent but associated with adverse outcomes.
- Patients with multiple risk factors for positive margins require careful surgical planning to achieve histologically clear margins, potentially via mapped serial excision or Mohs micrographic surgery.
