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• W2044846488 abstract "To the Editor: Welch et al1Welch A. Reid T. Knox J. Wilson M.L. Excision of melanoma in situ on nonchronically sun-exposed skin using 5-mm surgical margins.J Am Acad Dermatol. 2014; 71: 834-836Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar recently suggested 5-mm margins were adequate for melanoma in situ on nonchronically sun-exposed skin. However, the authors point out their academic institution included a large margin of normal-appearing skin with the excisional biopsy, and then an additional 5-mm margin was excised. We thank Welch et al1Welch A. Reid T. Knox J. Wilson M.L. Excision of melanoma in situ on nonchronically sun-exposed skin using 5-mm surgical margins.J Am Acad Dermatol. 2014; 71: 834-836Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar for recognizing that their small cohort of patients likely had a total of 8 to 9 mm of normal-appearing skin around the primary lesion removed. In addition, their study did not evaluate the entire margin, and standard breadloafing every 2 to 4 mm misses 63% to 81% of positive melanoma margins.2Kimyai-Asadi A. Katz T. Goldberg L.H. et al.Margin involvement after the excision of melanoma in situ: the need for complete en face examination of the surgical margins.Dermatol Surg. 2007; 33: 1434-1441Crossref PubMed Google Scholar Because the study effectively used an 8- to 9-mm margin and did not evaluate the full margin, and because margin guidelines refer to the primary lesion, we continue to recommend a 9-mm margin for all melanoma in situ. Certainly most melanoma in situ (approximately 86%) will be extirpated with only 5 mm, but not all.3Kunishige J.H. Brodland D.G. Zitelli J.A. Surgical margins for melanoma in situ.J Am Acad Dermatol. 2012; 66: 438-444Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar Excision of melanoma in situ on nonchronically sun-exposed skin using 5-mm surgical marginsJournal of the American Academy of DermatologyVol. 71Issue 4PreviewTo the Editor: Although melanoma in situ (MIS) has traditionally been treated by excision with 5-mm margins, recent guidelines have recommended 5- to 10-mm surgical margins, acknowledging that margins greater than 5 mm may be necessary for treatment of lentigo maligna.1 There is conflicting evidence regarding the necessary margin for excision of MIS on nonchronically sun-exposed skin (NCSES). One study found that conventional excision with 3-mm margins is sufficient to achieve negative histologic margins and very low rates of recurrence for MIS on sites other than the face. Full-Text PDF Reply to “Surgical margins for melanoma in situ: When 5-mm margins are really 9 mm”Journal of the American Academy of DermatologyVol. 72Issue 4PreviewTo the Editor: The contributions of Drs Kunishige, Brodland, and Zitelli in assessing the optimal surgical margins for melanoma in situ are appreciated, as are their comments concerning our recent study. Our study included a mixture of shave, punch, and excisional biopsy specimens. Although data are not available concerning the clinical margin, if any, taken at the time of initial biopsy specimen, it is clear that excision with 5-mm margins around the biopsy site and/or residual lesion resulted in negative histologic margins in 100% of cases, regardless of whether the biopsy margins were positive (55% of cases) or negative (45% of cases) for melanoma in situ. Full-Text PDF" @default.
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• W2044846488 title "Surgical margins for melanoma in situ: When 5-mm margins are really 9 mm" @default.
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