In a nutshell
The authors evaluated the effect of residual melanoma after excision of the primary tumor on prognosis in cutaneous melanoma.
Some background
Cutaneous melanoma is the most malignant form of skin cancer, which accounts for 90% of all deaths caused by skin cancer. When a cutaneous melanoma is suspected, an excisional biopsy (removal of the primary tumor) is usually performed under local anesthesia with a margin of 1-3 mm of normal skin. Once cutaneous melanoma is definitively diagnosed, a second operation called a "wide re-excision" is performed to remove a larger area (1-2 cm) around the primary area to be sure all tumor cells in that area have been removed. There is almost no data in the literature about the frequency of residual melanoma (cancer cells left after initial biopsy) in wide re-excision specimens and its impact on the prognosis (disease outlook) of these patients.
The aim of this study was to evaluate the impact of residual melanoma after an excisional biopsy on the frequency of a local recurrence and on overall survival.
Methods & findings
The study evaluated the outcomes of 692 patients who underwent a wide excision to recommended 1-2 cm margins. Average follow-up was 44.8 months.
3.6% of patients had residual melanoma on re-excision. More patients with residual melanoma had T4 tumors (melanoma is more than 4 mm thick) than those without residual melanoma. There was no significant difference in average tumor thickness or the presence of ulceration (discontinuation or break in a bodily membrane) between those with or without residual tumor.
However, 16% of those with residual melanoma experienced local recurrence (reappearance of the melanoma in the vicinity of a previously removed melanoma) compared to 2.7% of those without residual melanoma. 44% of those with residual melanoma experienced metastasis (spread of the cancer) in the sentinel lymph nodes (primary lymph nodes to which cancer will spread) compared to 22% of those without residual melanoma.
The 5-year overall survival rate (percentage of patients who did not die) of patients without residual melanoma was 87.5%, while the 5-year overall survival rate of patients with residual melanoma was 64%. During this time 14.3% of patients died of melanoma and 2.6% of other causes. The absence of ulceration was associated with a 3.48-fold increase in the chances of survival, while a sentinel lymph node testing negative for cancer was associated with a 2.7-fold increase in the chances of survival. Overall, a re-excision testing negative for residual melanoma was associated with a 2-fold increase in the chances of survival.
The bottom line
The authors concluded that residual melanoma is very rare after an excisional biopsy of the primary melanoma. However, when present it indicates a higher probability of local recurrence and a worse overall survival.
Published By :
EJSO
Date :
Mar 12, 2014
I am a 73 year female and recently underwent minor surgery for facial melanoma. After the surgery the surgeon stated he removed all of the melanoma. A week later we spoke and the biopsy confirmed residual melanoma, but I should not be alarmed or concerned,
I am very concerned and believe that a second opinion needs to happen. Before requesting my GP to schedule it, please advise exactly what type of examination needs to be done and by what type of specialist. Thank you
Hi! Please note that Medivizor does not offer nor substitute medical advice or diagnosis. Medivizor does not practice or provide medical services. You could speak to a dermatopathologist (someone who specializes in looking at diseases skin tissue under a microscope), who would remove some of the tissue and examine it to confirm the presence of residual cancer. Alternatively, you could speak to a dermatologist (specializing in skin diseases) or an oncologist (specializing in cancer), who would review very carefully your history and your biopsy results, and give you a comprehensive assessment of your risk and the best way forward. We wish you the very best of luck.