Are Positive Biopsy Margins in Melanoma Significant?: A Cohort Study of Micro- Versus Macroscopic Margin Status and Their Impact on Residual Disease and Survival.
Biopsy margins
Melanoma
Recurrence
Residual disease
Survival
Wide local excision
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
09 Oct 2024
09 Oct 2024
Historique:
received:
08
01
2024
accepted:
20
09
2024
medline:
9
10
2024
pubmed:
9
10
2024
entrez:
9
10
2024
Statut:
aheadofprint
Résumé
Presence of positive biopsy margins in melanoma can provoke anxiety over potential disease progression from delays to surgical excision, but their impact on outcomes is unknown. We aimed to compare the presence of residual melanoma in the surgical excision specimen and survival between patients with negative, microscopically positive, and macroscopically positive biopsy margins. Patients with cutaneous melanoma who underwent surgical excision over a 13-year period were included. Biopsy characteristics, residual disease in the surgical specimen, and overall and recurrence-free survival were compared between patients with negative, microscopically positive (only scar visible), and macroscopically positive (visible remaining melanoma) biopsy margins. Of 901 patients, 42.4%, 33.3%, and 24.3% had negative, microscopically positive, and macroscopically positive margins, respectively. The incidence of residual invasive melanoma in the surgical specimen varied (P < 0.001), occurring in 5.5%, 17.0%, and 74.9% of patients, respectively. Both microscopically and macroscopically positive margins were associated with residual disease (P < 0.001) but only the latter predicted worse overall (P = 0.013) and recurrence-free survival (P = 0.009). Kaplan-Meier estimated survival was comparable between those with negative and microscopically positive margins, but overall (P = 0.006) and recurrence-free survival (P = 0.004) were significantly worse in the macroscopically positive margin group. These patients had worse prognosis melanoma, with 33.8% being stage III disease, and 23.2% having positive sentinel lymph nodes. Patients and physicians may be reassured in the presence of microscopically positive biopsy margins which are not associated with worse survival, However, patients with macroscopically positive margins have poorer prognosis and should be treated within an acceptable time frame.
Sections du résumé
BACKGROUND
BACKGROUND
Presence of positive biopsy margins in melanoma can provoke anxiety over potential disease progression from delays to surgical excision, but their impact on outcomes is unknown. We aimed to compare the presence of residual melanoma in the surgical excision specimen and survival between patients with negative, microscopically positive, and macroscopically positive biopsy margins.
METHODS
METHODS
Patients with cutaneous melanoma who underwent surgical excision over a 13-year period were included. Biopsy characteristics, residual disease in the surgical specimen, and overall and recurrence-free survival were compared between patients with negative, microscopically positive (only scar visible), and macroscopically positive (visible remaining melanoma) biopsy margins.
RESULTS
RESULTS
Of 901 patients, 42.4%, 33.3%, and 24.3% had negative, microscopically positive, and macroscopically positive margins, respectively. The incidence of residual invasive melanoma in the surgical specimen varied (P < 0.001), occurring in 5.5%, 17.0%, and 74.9% of patients, respectively. Both microscopically and macroscopically positive margins were associated with residual disease (P < 0.001) but only the latter predicted worse overall (P = 0.013) and recurrence-free survival (P = 0.009). Kaplan-Meier estimated survival was comparable between those with negative and microscopically positive margins, but overall (P = 0.006) and recurrence-free survival (P = 0.004) were significantly worse in the macroscopically positive margin group. These patients had worse prognosis melanoma, with 33.8% being stage III disease, and 23.2% having positive sentinel lymph nodes.
CONCLUSIONS
CONCLUSIONS
Patients and physicians may be reassured in the presence of microscopically positive biopsy margins which are not associated with worse survival, However, patients with macroscopically positive margins have poorer prognosis and should be treated within an acceptable time frame.
Identifiants
pubmed: 39382747
doi: 10.1245/s10434-024-16301-w
pii: 10.1245/s10434-024-16301-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. Society of Surgical Oncology.
Références
Gershenwald JE, Scolyer RA, Hess KR, et al. 2017 Melanoma staging: evidence‐based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin 67(6): 472-492
Keung EZ, Gershenwald JE 2018 The eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system: implications for melanoma treatment and care. Expert Rev Anticancer Ther 18(8): 775-784
Swetter SM, Thompson JA, Albertini MR, et al. NCCN Guidelines® insights: melanoma: cutaneous, version 2.2021: featured updates to the NCCN guidelines. J Natl Compr Canc Netw. 2021;19(4):364–76.
doi: 10.6004/jnccn.2021.0018
pubmed: 33845460
Salopek TG, Slade J, Marghoob AA, et al. Management of cutaneous malignant melanoma by dermatologists of the American Academy of Dermatology. I. Survey of biopsy practices of pigmented lesions suspected as melanoma. J Am Acad Dermatol. 1995;33(3):441–50.
doi: 10.1016/0190-9622(95)91390-4
pubmed: 7657868
Ng JC, Swain S, Dowling JP, Wolfe R, Simpson P, Kelly JW. The impact of partial biopsy on histopathologic diagnosis of cutaneous melanoma: experience of an Australian tertiary referral service. Arch Dermatol. 2010;146(3):234–9.
doi: 10.1001/archdermatol.2010.14
pubmed: 20231492
Doolan BJ, Robinson AJ, Wolfe R, et al. Accuracy of partial biopsies in the management of cutaneous melanoma. Australas J Dermatol. 2019;60(3):209–13.
doi: 10.1111/ajd.13004
pubmed: 30773625
Kaiser S, Vassell R, Pinckney RG, Holmes TE, James TA. Clinical impact of biopsy method on the quality of surgical management in melanoma. J Surg Oncol. 2014;109(8):775–9.
doi: 10.1002/jso.23580
pubmed: 24862925
Frishberg DP, Balch C, Balzer BL, et al. Protocol for the examination of specimens from patients with melanoma of the skin. Arch Pathol Lab Med. 2009;133(10):1560–7.
doi: 10.5858/133.10.1560
pubmed: 19792045
Stell VH, Norton HJ, Smith KS, Salo JC, White RL. Method of biopsy and incidence of positive margins in primary melanoma. Ann Surg Oncol. 2007;14:893–8.
doi: 10.1245/s10434-006-9240-4
pubmed: 17119869
Crawford AB, Nessim C, Weaver J, van Walraven C. Wait times for melanoma surgery: is there an association with overall survival? Ann Surg Oncol. 2018;25(1):265–70. https://doi.org/10.1245/s10434-017-6146-2 .
doi: 10.1245/s10434-017-6146-2
pubmed: 29101504
Beesley VL, Hughes MCB, Smithers BM, et al. Anxiety and depression after diagnosis of high-risk primary cutaneous melanoma: a 4-year longitudinal study. J Cancer Surviv. 2020;14(5):712–9. https://doi.org/10.1007/s11764-020-00885-9 .
doi: 10.1007/s11764-020-00885-9
pubmed: 32519121
Tromme I, Sacré L, Hammouch F, Richez P, Degryse JM, Speybroeck N. Melanoma diagnosis: predictive value of macroscopic changes observed by the patient. Melanoma Res. 2018;28(6):611–7. https://doi.org/10.1097/CMR.0000000000000496 .
doi: 10.1097/CMR.0000000000000496
pubmed: 30192302
von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573–7. https://doi.org/10.7326/0003-4819-147-8-200710160-00010 .
doi: 10.7326/0003-4819-147-8-200710160-00010
Ahmadi O, Das M, Hajarizadeh B, Mathy JA. Impact of shave biopsy on diagnosis and management of cutaneous melanoma: a systematic review and meta-analysis. Ann Surg Oncol. 2021;28(11):6168–76.
doi: 10.1245/s10434-021-09866-3
pubmed: 33782802
pmcid: 8006869
Molenkamp BG, Sluijter BJR, Oosterhof B, Meijer S, Van Leeuwen PAM. Non-radical diagnostic biopsies do not negatively influence melanoma patient survival. Ann Surg Oncol. 2007;14(4):1424–30. https://doi.org/10.1245/s10434-006-9302-7 .
doi: 10.1245/s10434-006-9302-7
pubmed: 17225977
pmcid: 1914261
Egnatios GL, Dueck AC, MacDonald JB, et al. The impact of biopsy technique on upstaging, residual disease, and outcome in cutaneous melanoma. Am J Surg. 2011;202(6):771–8. https://doi.org/10.1016/j.amjsurg.2011.06.037 .
doi: 10.1016/j.amjsurg.2011.06.037
pubmed: 22000117
Namin AW, Zitsch RP III. Impact of biopsy modality on the management of cutaneous melanoma of the head and neck. Otolaryngol Neck Surg. 2018;158(3):473–8.
doi: 10.1177/0194599817740568
Martin RC II, Scoggins CR, Ross MI, et al. Is incisional biopsy of melanoma harmful? Am J Surg. 2005;190(6):927–32.
doi: 10.1016/j.amjsurg.2005.08.020
Trifirò G, Verrecchia F, Soteldo J, et al. Modification of lymphoscintigraphic sentinel node identification before and after excisional biopsy of primary cutaneous melanoma. Melanoma Res. 2008;18(6):373–7.
doi: 10.1097/CMR.0b013e328307c231
pubmed: 19011509
Sondak VK, Zager JS. Who is to blame for false-negative sentinel node biopsies in melanoma? Ann Surg Oncol. 2010;17:670–3.
doi: 10.1245/s10434-009-0857-y
pubmed: 19953329
El Sharouni MA, Aivazian K, Witkamp AJ, et al. Association of histologic regression with a favorable outcome in patients with stage 1 and stage 2 cutaneous melanoma. JAMA Dermatol. 2021;157(2):166–73.
doi: 10.1001/jamadermatol.2020.5032
pubmed: 33355600
Kerns MJJ, Darst MA, Olsen TG, Fenster M, Hall P, Grevey S. Shrinkage of cutaneous specimens: formalin or other factors involved? J Cutan Pathol. 2008;35(12):1093–6.
doi: 10.1111/j.1600-0560.2007.00943.x
pubmed: 18544064
Ramiscal JAB, Stern SL, Wilson AK, et al. Does residual invasive disease in wide local excision after diagnosis with partial biopsy technique influence survival in melanoma? Matched-pair analysis of multicenter selective lymphadenectomy trial I and II. J Am Coll Surg. 2022;235(1):49. https://doi.org/10.1097/XCS.0000000000000263 .
doi: 10.1097/XCS.0000000000000263
pubmed: 35703962
Bolshinsky V, Lin MJ, Serpell J, et al. Frequency of residual melanoma in wide local excision (WLE) specimens after complete excisional biopsy. J Am Acad Dermatol. 2016;74(1):102–7.
doi: 10.1016/j.jaad.2015.08.065
pubmed: 26601566
Rashid S, Tsao H. Effect of the COVID-19 pandemic on delayed skin cancer services. Dermatol Clin. 2021;39(4):627–37.
doi: 10.1016/j.det.2021.05.015
pubmed: 34556252
pmcid: 8162820