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Predicting positive margins in resection of cutaneous melanoma of the head and neck

Authors

  • J. Jared Christophel MD, MPH,

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery , University of Virginia Health System, Charlottesville
    2. Department of Health Evaluation Sciences , University of Virginia Health System, Charlottesville
    • Department of Otolaryngology–Head and Neck Surgery, University of Virginia Health System, PO Box 800713, Charlottesville, VA 22908
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  • Andrew K. Johnson BS,

    1. the University of Virginia School of Medicine , Charlottesville, Virginia, U.S.A
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  • Timothy L. McMurry PhD,

    1. Department of Health Evaluation Sciences , University of Virginia Health System, Charlottesville
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  • Stephen S. Park MD,

    1. Department of Otolaryngology–Head and Neck Surgery , University of Virginia Health System, Charlottesville
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  • Paul A. Levine MD

    1. Department of Otolaryngology–Head and Neck Surgery , University of Virginia Health System, Charlottesville
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  • Presented at the Triological Society Annual Meeting at COSM, San Diego, California, U.S.A., April 18–22, 2012.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Head and neck melanoma surgeons must achieve negative margins before performing margin compromising reconstructions such as a local flap closure. This often necessitates staged operations, including further margin resection. Peripheral sampling is often used before definitive resection to help guide the extent of the resection. If melanoma margin status could be predicted based on lesion characteristics, the surgeon could be more confident in performing definitive closure immediately after resection of some lesions or confident in the need to take larger margins in predictably extensive lesions.

Study Design:

Retrospective review and logistic regression analysis.

Methods:

Institutional review board approval was obtained. Out of 637 patients treated for head and neck melanoma by the Department of Otolaryngology–Head and Neck Surgery in the last 10 years, 409 patients had primary resection with available histopathologic margin status used as the outcome variable. Predictor variables of demographics, lesion size, pathologic subtype, location on face, and depth of invasion were collected.

Results:

Histopathologic margin status could be predicted by age but not by the other predictor variables.

Conclusions:

In this large series of head and neck melanomas excised using National Comprehensive Cancer Network–recommended margins, histopathologic margin status could be predicted based on age but not on lesion characteristics. This finding is surprising given the published data showing that melanoma in situ has a higher rate of positive margin compared to subtypes of invasive melanoma. It reinforces the need for delaying reconstruction until margins are clear or performing reconstruction at a time of resection that does not compromise the ability to resect margins further (e.g., skin graft).

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