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Skin Mapping With Punch Biopsies for Defining Margins in Melanoma: When You Don’t Know How Far to Go

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Wide local excision of primary cutaneous melanoma usually provides clear margins and excellent local control. Nonclassical presentations of cutaneous melanoma, however, can challenge this treatment algorithm. Specifically, persistent melanoma-in-situ (MIS) at the margin not suspected clinically makes planning definitive wide local excision more difficult. We hypothesized that the use of punch biopsies as a mapping tool would allow us to obtain clear margins in these challenging cases.

Methods

Punch biopsies were performed at sites 1 to 2 cm from prior positive margins. Subsequent wide local excision was planned, including all punch biopsy sites with positive findings: atypical melanocytic hyperplasia, MIS, or invasive melanoma. The management of three patients was documented prospectively. Standard surgical techniques were used independent of an experimental protocol. Medical records were reviewed, and data were summarized under institutional review board protocol HIC 10803.

Results

The results of punch biopsies identified invasive melanoma, MIS, or atypical melanocytic hyperplasia in all three patients with MIS at the margins. All three mapping procedures were well tolerated and resulted in resection with negative margins in a single definitive resection.

Conclusion

Melanoma mapping with punch biopsy technique allows for definitive excision in cases when disease persists at the margins of the reexcision or in cases with unclear clinical examinations.

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Authors and Affiliations

  1. Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA

    Lynn Dengel MD & Kristin Turza MD

  2. Department of Dermatology, University of Virginia Health System, Charlottesville, VA, USA

    Mary-Margaret B. Noland MD

  3. Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA

    James W. Patterson MD

  4. Department of Surgery, University of Virginia Health System, PO Box 800709, Room 4580, Private Clinics Building, Hospital Drive, Charlottesville, VA, 22908, USA

    Craig L. Slingluff Jr. MD

Authors
  1. Lynn Dengel MD
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  2. Kristin Turza MD
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  3. Mary-Margaret B. Noland MD
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  4. James W. Patterson MD
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  5. Craig L. Slingluff Jr. MD
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Corresponding author

Correspondence to Craig L. Slingluff Jr. MD.

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Dengel, L., Turza, K., Noland, MM.B. et al. Skin Mapping With Punch Biopsies for Defining Margins in Melanoma: When You Don’t Know How Far to Go. Ann Surg Oncol 15, 3028–3035 (2008). https://doi.org/10.1245/s10434-008-0138-1

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  • DOI: https://doi.org/10.1245/s10434-008-0138-1

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