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• W2999808224 abstract "To the Editor: We thank Rodríguez-Jiménez et al for articulating the popular feeling that 5-mm margins should be enough for melanoma in situ (MIS). Most practitioners who feel this way concede lentigo maligna (LM) requires more than a 5-mm margin, but are not so sure about non-LM MIS. With 2335 MIS cases, our study definitively showed subclinical extension of LM is similar to that of MIS. A 5-mm margin was not adequate for either subtype. The clearance rate was 79% for LM and 83% for MIS, 84% for trunk and extremity location, and 88% for lesions with diameters of less than 1 cm. These findings were recently corroborated by a multicenter prospective study of 378 in situ lesions.1Ellison P.M. Zitelli J.A. Brodland D.G. Mohs surgery for melanoma: a prospective multicenter study.J Am Acad Dermatol. 2019; 81: 764-774Abstract Full Text Full Text PDF Scopus (28) Google Scholar That MIS can have subclinical extension beyond 5 mm is clear to those who regularly examine the entire margin (Fig 1). That said, when we looked at the 140 lesions on the trunk and extremities that were also ≤9 mm in diameter, 95% cleared with 6 mm.2Kunishige J.H. Doan L. Brodland D.G. Zitelli J.A. 9-mm surgical margin required for both LM and MIS as diagnosed in real-world community practice.J Am Acad Dermatol. 2019; 81: e117-e118Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar This suggests there may be select lesions on nonphotodamaged skin that can be treated with a 5- or 6-mm margin, especially if an ellipse removing additional tissue is used. All but 2 of the 60 cases reported by Rodríguez-Jiménez et al were on the trunk and extremities. If these were minute and discrete lesions on nonphotodamaged skin, their findings are compatible with ours. A prospective study of the safety of 5-mm margins excised with an ellipse and examined via bread-loafing at standardized intervals is much needed. Regarding the impact of HMB-45 on clearance rates, margin requirements before and after the institution of MART-1 immunostain were compared, and no difference was found.3Kunishige J.H. Doan L. Brodland D.G. Zitelli J.A. Comparison of surgical margins for lentigo maligna and melanoma in situ.J Am Acad Dermatol. 2019; 81: 204-212Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar If the 2 genital and 53 acral lesions are omitted from the trunk and extremity cohort, trunk and extremity clearance rate for 6-mm margins changes only from 83.7% to 84.1%. Five-millimeter lateral margins are appropriate in the treatment of melanoma in situJournal of the American Academy of DermatologyVol. 82Issue 5PreviewTo the Editor: We read with great interest the original papers by Kunishige et al published in 2019 and in 2015.1,2 We found striking the high number of lesions that, according to their results, require at least margins >6 mm in the treatment of melanoma in situ (MIS) with Mohs micrographic surgery, with up to 18% of operations potentially leaving melanoma nests behind. Moreover, for nonlentigo maligna (non-LM) MIS, the standard treatment in daily practice in many centers, including ours, demonstrates to us that 5-mm margins are indeed adequate. Full-Text PDF" @default.
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• W2999808224 date "2020-05-01" @default.
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• W2999808224 title "Reply to: “Five-millimeter lateral margins are appropriate in the treatment of melanoma in situ”" @default.
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• W2999808224 doi "https://doi.org/10.1016/j.jaad.2020.01.008" @default.
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