Dataset Information

Patterns of failure following the excision of in-transit lesions in melanoma and the influence of excisional margins.

ABSTRACT:

Background and objectives

To describe the patterns of failure in patients with in-transit (IT) melanoma undergoing surgical excision.

Methods

A retrospective review of patients who underwent their first IT lesion(s) resection between May 2005 and September 2014. Cumulative incidence of local failure (new lesion within 2 cm of IT resection) was estimated. Associations between clinicopathologic characteristics, local failure, and any recurrence were analyzed.

Results

One hundred and thirty patients presented to our institution with IT disease over the study period and met the inclusion criteria. The 2-year cumulative incidence of local failure was 19.5%. Twenty-four patients developed disease within 2 cm of the resected IT disease; however, only eight were isolated local events. Cumulative incidence of local failure and of any disease differed with respect to less than 1 year disease-free interval (DFI) from primary melanoma to first IT event, and having greater than 1 IT lesion at presentation. Incidence of local failure was not found to differ with respect to gross margin greater than 5 mm, after adjusting for DFI and greater than 1 IT lesions.

Conclusions

Patients with greater than 1 IT lesion and a DFI less than 1 year are at a higher risk of failure after surgical excision of a first IT event. Very few failures were isolated local disease within 2 cm of the IT resection scar, regardless of IT excision margin.

SUBMITTER: Gonzalez AB

PROVIDER: S-EPMC6175616 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Publications

Patterns of failure following the excision of in-transit lesions in melanoma and the influence of excisional margins.

Gonzalez Alexandra B AB Baum Christian L CL Brewer Jerry D JD Arpey Christopher J CJ Harmsen William S WS Suman Vera J VJ Markovic Svetomir N SN Jakub James W JW

Journal of surgical oncology 20180816 4

<h4>Background and objectives</h4>To describe the patterns of failure in patients with in-transit (IT) melanoma undergoing surgical excision.<h4>Methods</h4>A retrospective review of patients who underwent their first IT lesion(s) resection between May 2005 and September 2014. Cumulative incidence of local failure (new lesion within 2 cm of IT resection) was estimated. Associations between clinicopathologic characteristics, local failure, and any recurrence were analyzed.<h4>Results</h4>One hund ...[more]

PMID: 30114337

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Project description:ImportanceNational Comprehensive Cancer Network guidelines for melanoma have consistently recommended wide local excision as the standard of care since their inception. Although surgery with more comprehensive margin assessment (eg, Mohs surgery) has been advocated for certain subsets of melanoma, how often these techniques are used in clinical practice is uncertain.ObjectiveTo examine trends in the use of comprehensive margin assessment surgery for melanoma by tracking claims data for Mohs surgery.Design, setting, and participantsThis national cross-sectional analysis examined claims data from the Optum Clinformatics Data Mart, a nationally representative database. The study cohort consisted of 79 108 patients undergoing surgical excision for melanoma from January 1, 2001, through December 31, 2016. Data were analyzed from January 1, 2001, through December 31, 2016.Main outcomes and measuresThe primary outcome was the likelihood of a melanoma being treated with Mohs surgery over time, evaluated by multivariable logistic regression and expressed as the odds of treatment per additional calendar year.ResultsAmong 79 108 patients with melanoma (median age, 63 years [interquartile range {IQR}, 51-73]; 47 407 men [59.9%]), 75 047 were treated with conventional excision (median age, 62 years [IQR, 50-73 years]; 44 786 men [59.7%]) and 4061 with Mohs surgery (median age, 67 years [IQR, 56-76 years]; 2621 men [64.5%]). Mohs surgery was used in 5.1% of all surgical cases, with the rate of Mohs surgery increasing 304% from 2.6% in 2001 to 7.9% in 2016. Odds of receiving Mohs surgery for melanoma increased significantly in more recent calendar years (odds ratio [OR], 1.02 per calendar year; 95% CI, 1.01-1.03; P < .001). Immunohistochemistry (IHC) use was only coded with Mohs surgery in 1087 cases (26.8%), and the odds of receiving Mohs surgery with IHC increased in more recent calendar years (OR, 1.13 per calendar year; 95% CI, 1.10-1.15; P < .001). Use of Mohs surgery and Mohs surgery with IHC for melanoma differed widely across geographic census divisions with greater than 3-fold variation between the regions with highest and lowest use in every period (eg, for 2013 through 2016, the East South Central region used Mohs surgery in 8.8% of melanoma excisions compared with 2.6 in the New England region).Conclusions and relevanceDespite stable guidelines for melanoma surgery, the results of this study suggest that surgical practices for melanoma are evolving. Wide variations in surgical practice patterns for melanoma are present in the United States. This study's findings suggest that the effect of variations in surgical techniques on outcomes requires scrutiny and further study.

Dataset Information

Patterns of failure following the excision of in-transit lesions in melanoma and the influence of excisional margins.

Background and objectives

Methods

Results

Conclusions

Publications

Patterns of failure following the excision of in-transit lesions in melanoma and the influence of excisional margins.

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