Are Positive Biopsy Margins in Melanoma Significant?: A Cohort Study of Micro- Versus Macroscopic Margin Status and Their Impact on Residual Disease and Survival
Alex Lee1,2, Boaz Wong1,2, Heidi Li1
1Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
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View abstract on PubMed
Microscopically positive melanoma biopsy margins do not worsen patient survival, but macroscopically positive margins indicate residual disease and poorer prognosis. Prompt treatment is crucial for patients with macroscopically positive margins to improve outcomes.
Area of Science:
- Oncology
- Dermatology
- Surgical Pathology
Background:
- Positive biopsy margins in melanoma can cause patient anxiety regarding disease progression.
- The impact of positive biopsy margins on melanoma outcomes remains unclear.
- This study compares outcomes based on negative, microscopically positive, and macroscopically positive biopsy margins.
Purpose of the Study:
- To compare the incidence of residual melanoma in surgical specimens.
- To evaluate the association between biopsy margin status and patient survival.
- To determine the prognostic significance of different types of positive biopsy margins in cutaneous melanoma.
Main Methods:
- A retrospective analysis of 901 cutaneous melanoma patients over 13 years.
- Classification of biopsy margins into negative, microscopically positive (scar only), and macroscopically positive (visible melanoma).
- Comparison of residual disease in surgical excision specimens and survival rates (overall and recurrence-free).
Main Results:
- 42.4% negative, 33.3% microscopically positive, and 24.3% macroscopically positive margins were observed.
- Residual invasive melanoma was found in 5.5% (negative), 17.0% (microscopically positive), and 74.9% (macroscopically positive) of cases.
- Macroscopically positive margins, unlike microscopically positive margins, significantly predicted worse overall and recurrence-free survival, with these patients often presenting with advanced stage disease.
Conclusions:
- Microscopically positive melanoma biopsy margins are not associated with adverse survival outcomes.
- Macroscopically positive margins indicate a poorer prognosis and necessitate timely surgical re-excision.
- Patients with macroscopically positive margins require prompt treatment to mitigate risks associated with residual melanoma and advanced disease stages.