Incomplete Excisions of Melanocytic Lesions: Rates and Risk Factors
DOI:
https://doi.org/10.2340/00015555-3784Keywords:
incomplete excision, surgery, melanocytic lesion, melanoma, naevusAbstract
Incomplete excisions of melanocytic lesions occur despite the intention of complete removal. The aim of this study was to determine the incomplete excision rates for benign and malignant melanocytic lesions and the associated risk factors. Demographic, clinical, and histopathological data possibly associated with incomplete excision were collected from 2,782 consecutive excisions between 2014 and 2015. Of these, 269 melanocytic lesions (9.7%) were incompletely excised. Multivariate analysis revealed the following risk factors for significantly higher incomplete excision rates: lesions located in the head and neck area (odds ratio (OR) 3.95, 95% confidence interval (95% CI) 2.35–6.65), surgery performed by general practitioners (OR 3.01, 95% CI 2.16–4.19), the use of a punch excision technique (OR 2.83, 95% CI 1.96–4.08), and excision of non-dysplastic naevi (OR 1.58, 95% CI 1.11–2.23). In conclusion, more caution should be taken when excising melanocytic lesions in the head and neck area, general practitioners require more surgical training, and punch excisions of melanocytic lesions should be avoided.
Downloads
References
Eriksson T, Tinghög G. Societal cost of skin cancer in Sweden in 2011. Acta Derm Venereol 2015; 95: 347-348.
DOI: https://doi.org/10.2340/00015555-1938
Guy GP, Jr., Thomas CC, Thompson T, Watson M, Massetti GM, Richardson LC. Vital signs: melanoma incidence and mortality trends and projections - United States, 1982-2030. MMWR Morb Mortal Wkly Rep 2015; 64: 591-596.
Sacchetto L, Zanetti R, Comber H, Bouchardy C, Brewster DH, Broganelli P, et al. Trends in incidence of thick, thin and in situ melanoma in Europe. Eur J Cancer 2018; 92: 108-118.
DOI: https://doi.org/10.1016/j.ejca.2017.12.024
National Cancer Control Indicators (NCCI) - Cancer Australia (Incidence, by sex, 1982-2019 melanoma); 2019 [cited 2020 Nov 12]. Available from: https://ncci.canceraustralia.gov.au/diagnosis/cancer-incidence/cancer-incidence.
NORDCAN. Cancer incidence, mortality, prevalence and prediction in the Nordic Countries; 2019 [cited 2020 Nov 12]. Available from http://www-dep.iarc.fr/NORDCAN/SW/frame.asp or http: //www-dep.iarc.fr/NORDCAN/SW/StatsFact.asp?cancer=310&country=0.
Confederation of Regional Cancer Centers in Sweden. [National guidelines - Malignant melanoma]; 2020 [cited 2020 Nov 12]. Available from: http://www.cancercentrum.se/samverkan/cancerdiagnoser/hud-och-ogon/vardprogram/.
European Dermatology Forum. Guideline on the diagnosis and treatment of melanoma; 2012 [cited 2020 Nov 12]. Available from: https: //www.edf.one.
NCCN - National Comprehensive Cancer Network; 2020 [cited 2020 Nov 12]. Available from: https://www.nccn.org
Swetter SM, Tsao H, Bichakjian CK, Curiel-Lewandrowski C, Elder DE, Gershenwald JE, et al. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol 2019; 80: 208-250.
DOI: https://doi.org/10.1016/j.jaad.2018.08.055
Lindelöf B, Hedblad MA, Ringborg U. [Nevus or malignant melanoma? Correct diagnostic competence results in lower costs]. Lakartidningen 2008; 105: 2666-2669 (in Swedish).
Petty AJ, Ackerson B, Garza R, Peterson M, Liu B, Green C, et al. Meta-analysis of number needed to treat for diagnosis of melanoma by clinical setting. J Am Acad Dermatol 2020; 82: 1158-1165.
DOI: https://doi.org/10.1016/j.jaad.2019.12.063
Moscarella E, Pampena R, Palmiotti G, Bonamonte D, Brancaccio G, Piccolo V, et al. A meta-analysis on the influence of partial biopsy of primary melanoma on disease recurrence and patient survival. J Eur Acad Dermatol Venereol 2020; 34: 279-284.
DOI: https://doi.org/10.1111/jdv.15903
Fleming NH, Egbert BM, Kim J, Swetter SM. Reexamining the threshold for reexcision of histologically transected dysplastic nevi. JAMA Dermatol 2016; 152: 1327-1334.
DOI: https://doi.org/10.1001/jamadermatol.2016.2869
King R, Hayzen BA, Page RN, Googe PB, Zeagler D, Mihm MC, Jr. Recurrent nevus phenomenon: a clinicopathologic study of 357 cases and histologic comparison with melanoma with regression. Mod Pathol 2009; 22: 611-617.
DOI: https://doi.org/10.1038/modpathol.2009.22
Botella-Estrada R, Nagore E, Sopena J, Cremades A, Alfaro A, Sanmartín O, et al. Clinical, dermoscopy and histological correlation study of melanotic pigmentations in excision scars of melanocytic tumours. Br J Dermatol 2006; 154: 478-484.
DOI: https://doi.org/10.1111/j.1365-2133.2005.07105.x
Elmore JG, Barnhill RL, Elder DE, Longton GM, Pepe MS, Reisch LM, et al. Pathologists' diagnosis of invasive melanoma and melanocytic proliferations: observer accuracy and reproducibility study. BMJ 2017; 357: j2813.
DOI: https://doi.org/10.1136/bmj.j2813
Bakhai M, Hopster D, Wakeel R. A retrospective study comparing the accuracy of prehistology diagnosis and surgical excision of malignant melanomas by general practitioners and hospital specialists. Clin Exp Dermatol 2010; 35: 63-67.
DOI: https://doi.org/10.1111/j.1365-2230.2009.03507.x
Haw WY, Rakvit P, Fraser SJ, Affleck AG, Holme SA. Skin cancer excision performance in Scottish primary and secondary care: a retrospective analysis. Br J Gen Pract 2014; 64: e465-e470.
DOI: https://doi.org/10.3399/bjgp14X680929
Herd RM, Hunter JA, McLaren KM, Chetty U, Watson AC, Gollock JM. Excision biopsy of malignant melanoma by general practitioners in south east Scotland 1982-91. BMJ 1992; 305: 1476-1478.
DOI: https://doi.org/10.1136/bmj.305.6867.1476
Khorshid SM, Pinney E, Bishop JA. Melanoma excision by general practitioners in north-east Thames region, England. Br J Dermatol 1998; 138: 412-417.
DOI: https://doi.org/10.1046/j.1365-2133.1998.02116.x
Murchie P, Sinclair E, Lee AJ. Primary excision of cutaneous melanoma: does the location of excision matter. Br J Gen Pract 2011; 61: 131-134.
DOI: https://doi.org/10.3399/bjgp11X556272
Zgraj O, Taczanowska-Niemczuk A, Gorecki W. Facial location and operating room environment are the risk factors for incomplete excision of melanocytic Nevi. Eur J Pediatr Surg 2019; 29: 458-461.
DOI: https://doi.org/10.1055/s-0038-1672145
Miller CJ, Shin TM, Sobanko JF, Sharkey JM, Grunyk JW, Elenitsas R, et al. Risk factors for positive or equivocal margins after wide local excision of 1345 cutaneous melanomas. J Am Acad Dermatol 2017; 77: 333-340.e331.
DOI: https://doi.org/10.1016/j.jaad.2017.03.025
Zhang J, Miller CJ, Sobanko JF, Shin TM, Etzkorn JR. Frequency of and factors associated with positive or equivocal margins in conventional excision of atypical intraepidermal melanocytic proliferations (AIMP): a single academic institution cross-sectional study. J Am Acad Dermatol 2016; 75: 688-695.
DOI: https://doi.org/10.1016/j.jaad.2016.05.034
Hilari H, Llorca D, Traves V, Villanueva A, Serra-Guillén C, Requena C, et al. Conventional surgery compared with slow Mohs micrographic surgery in the treatment of lentigo maligna: a retrospective study of 62 cases. Actas Dermosifiliogr 2012; 103: 614-623.
DOI: https://doi.org/10.1016/j.ad.2011.12.009
Mills JK, White I, Diggs B, Fortino J, Vetto JT. Effect of biopsy type on outcomes in the treatment of primary cutaneous melanoma. Am J Surg 2013; 205: 585-590; discussion 590.
DOI: https://doi.org/10.1016/j.amjsurg.2013.01.023
Goulding JM, Levine S, Blizard RA, Deroide F, Swale VJ. Dermatological surgery: a comparison of activity and outcomes in primary and secondary care. Br J Dermatol 2009; 161: 110-114.
DOI: https://doi.org/10.1111/j.1365-2133.2009.09228.x
Murchie P, Delaney EK, Thompson WD, Lee AJ. Excising basal cell carcinomas: comparing the performance of general practitioners, hospital skin specialists and other hospital specialists. Clin Exp Dermatol 2008; 33: 565-571.
DOI: https://doi.org/10.1111/j.1365-2230.2008.02710.x
Salmon P, Mortimer N, Rademaker M, Adams L, Stanway A, Hill S. Surgical excision of skin cancer: the importance of training. Br J Dermatol 2010; 162: 117-122.
DOI: https://doi.org/10.1111/j.1365-2133.2009.09548.x
Hansen C, Wilkinson D, Hansen M, Soyer HP. Factors contributing to incomplete excision of nonmelanoma skin cancer by Australian general practitioners. Arch Dermatol 2009; 145: 1253-1260.
DOI: https://doi.org/10.1001/archdermatol.2009.270
van Rijsingen MC, Vossen R, van Huystee BE, Gorgels WJ, Gerritsen MJ. Skin tumour surgery in primary care: do general practitioners need to improve their surgical skills? Dermatology 2015; 230: 318-323.
DOI: https://doi.org/10.1159/000371812
Zakhem GA, Terushkin V, Mu EW, Polsky D, Meehan SA. Margin assessment for punch and shave biopsies of dysplastic nevi. J Drugs Dermatol 2018; 17: 810-812.
Published
How to Cite
License
Copyright (c) 2021 Sofia Berglund, Eva Johansson Backman, Zahra Baldawi, Linda Horn, Rebecca Arbin Borsiin, Michelle Marjanovic, Thea Christoffersson, Martin Gillstedt, John Paoli
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.