Table 2.
Studies examining clearance margins in melanoma in situ
| Author | Study type | Sample size | Distinction between MIS and LM? | Anatomic site, n (%) | Clinical margin needed for histologic clearance | Follow-up | Recurrence rate |
|---|---|---|---|---|---|---|---|
| Mohs micrographic surgery | |||||||
| Robinson [15] | Prospective cohort study, single surgeon | 16 | Yes; LM only | Head: 16 (100%) | 69% clear with 6–10 mm | Range 5–9 years | 6.25% |
| Zitelli [16] | Prospective cohort study, single surgeon | 184 | No |
Head/neck: 106 (58%) Hands/feet: 6 (3%) Trunk: 34 (18%) Extremities: 38 (21%) |
83% clear with 6 mma 95% clear with 9 mma 97% clear with 12 mma |
At least 5 years | 0.5%a |
| Zalla [17] | Retrospective chart review, two surgeons | 46 | No |
Head/neck: 44 (96%) Acral: 2 (4%) |
Average 8.3 mm (range 3–19 mm) 50% clear with ≤ 6 mm 83% clear with ≤ 10 mm 96% clear with ≤ 15 mm |
Average 16 months (range 1–32) | 0% |
| Albertini [14] | Retrospective chart review, single center | 42 | No |
Head/neck: 41 (98%) Trunk: 1 (2%) |
41% clear with ≤ 6 mm 59% clear with ≤ 10 mm 88% clear with ≤ 15 mm 100% clear with ≤ 18 mm |
N/A | N/A |
| Bricca [18] | Prospective cohort study, single center | 331 | No | Head/neck: 331 (100%) |
89.1% clear with 6 mm 98.5% clear with 9 mm |
Mean 58 months (range 0–238.8) | 0.3% |
| Kunishige [23] | Retrospective database review | 1120 | No |
Head/neck: 668 (60%) Trunk: 197 (18%) Extremity: 232 (21%) Hands/feet: 20 (2%) Palm: 2 (< 1%) Genitalia: 1 (< 1%) |
86% clear with 6 mm margins 98.9% clear with 9 mm margins 99.4% clear with 12 mm margins |
Mean 4.7 years (range 0.02–23.5) | 0.3% |
| Stigall [27] | Retrospective database review | 882 | No |
Trunk: 427 (48%) Proximal extremity: 455 (52%) |
83% clear with 6 mm margins 97% clear with 9 mm margins |
Median 45 months (range 1–340) | 0.1% |
| Felton [22] | Retrospective database review, single institution | 343 | No | Head/neck: 343 (100%) |
65% clear with 5 mm margins 75% clear with 8 mm margins 92% clear with 10 mm margins 97% clear with 15 mm margin |
Mean 29 months | 0.3% |
| Valentin-Nogueras [20] | Retrospective database review, single institution | 982 | No |
Head/neck: 53.2%a Other: 46.8%a |
Mean clearance margin 7.1 mm | Mean 3.73 years (range 0–9.54) | 0.41% |
| Ellison [26] | Prospective, multicenter cohort study | 377 | No |
Head/neck: 266 (71%) Trunk: 64 (17%) Extremities: 42 (11%) Hands/feet/genitalia: 5 (1%) |
77.4% clear with 6 mm margin 92.1% clear with 9 mm margin 97.1% clear with 12 mm margin |
N/A | N/A |
| Kunishige [24] | Retrospective database review | 2335 |
Yes; LM: 1506 (64%) MIS: 829 (36%) |
Head/neck: 1362 (58%) Trunk/extremity: 973 (42%) |
79% LM/89% MIS clear with 6 mm 97% LM/MIS clear with 12 mm |
Median 4.5 years (range 0.2–23.5) |
5-year/10-year 0.27%/0.33% LM 0.00&/0.12% MIS |
| Kunishige [25] | Retrospective database review | 404 |
LM: 104 (26%) MIS: 300 (74%) |
Trunk/extremities: 404 (100%) |
< 0.8 cm in diameter 92.4% clear with 6 mm margin < 0.9 cm in diameter 94.3% clear with 6 mm margin < 1.0 cm in diameter 90.3% clear with 6 mm margin |
N/A | N/A |
| Foxton [19] | Retrospective chart review, single center | 62 | No |
Head/neck: 55 (89%) Trunk/extremities: 7 (11%) |
68% clear with 6 mm 92% clear with 9 mm 100% clear with 12 mm |
Range 3–30 months | 0% |
| Heath [21] | Retrospective database review, single institution | 529 | No |
Head/neck: 502 (95%) Trunk: 7 (1%) Extremities: 20 (4%) |
Mean surgical margin 7 mm ± 3.8 mm | Median 62.1 months | 2.5% |
| Staged excision | |||||||
| Agarwal-Antal [35] | Prospective cohort study, single center | 93 | Yes; LM only |
Head/neck: 69 (74%) Other: 24 (26%) |
42% clear with 5 mm 69% clear with 10 mm 84% clear with 15 mm 91% clear with 20 mm |
N/A | N/A |
| Huilgol [32] | Prospective cohort study, single center | 125 | Yes; LM only | Head/neck: 125 (100%) |
70% clear with 5 mm 80% of primary LM clear with 5 mm |
Mean 38 ± 25 months (range 3–100) |
5-year 0.05% |
| Jejurikar [30] | Retrospective chart review, single center | 42 | Yes; LM only | Head/neck: 42 (100%) | Mean clearance margin 10 ± 5 mm | Average 953 ± 246 days (range 473–1373) | 0% |
| Demirci [31] | Retrospective chart review, single center | 26 | Yes; LM only | Periocular 26 (100%) | Mean clearance margin 13 mm (range 5–25 mm) | Mean 49 months (range 9–112) | 2.5% |
| Hazan [34] | Retrospective chart review, single surgeon | 91 | Yes, LM only | Head/neck: 95%a | Mean clearance margin 7.1 mm (range 5–18 mm) | N/A | N/A |
| Moller [29] | Retrospective chart review, single institution | 49 | No | Head/neck: 49 (100%) | 76% clear with 5 mm margins | Median 14 months (range 1–36 | 0% |
| Shumaker [36] | Retrospective chart review, single institution | 18 | No | Periocular: 18 (100%) |
Average clearance margin 7.3 mm 33% clear with 5 mm margins |
Average 95.1 months (range 40–183) | 17% |
| Abdelmalek [33] | Retrospective chart review, single institution | 225 | Yes; LM only |
Head/neck: 67.9%a Upper extremity: 11.9%a |
Mean clearance margin 6.6 mm (range 3–35 mm) | Mean 32.3 months (range 2–96) | 1.7%a |
| Wilson [38] | Retrospective chart review, single surgeon | 58 | Yes; LM only |
Head/neck:71% Trunk: 10% Extremity: 19% |
54% (28/51) clear with 5 mm clinical margins 46% clearance rate on head and neck Of 23 not clear by 5 mm margins, average margin 10.4 ± 1.0 mm (median 9 mm, range 9–27 mm) |
Median 138 months (range 37–330) | 5.9% |
| De Vries [39] | Retrospective database review, single institution | 100 | Yes; LM only |
Head/neck: 97 (97%) Other: 3 (3%) |
88% clear with 8 mm margina 97% clear with 13 mm margina 100% clear with 18 mm margina |
Median 60 months | 4%a |
| Garcia [41] | Retrospective chart review, single institution | 29 |
Yes; LM: 8 (27.6%) MIS: 21 (72.4%) |
Head/neck: 27 (93%) Trunk/extremities: 2 (7%) |
55% clear with 5 mm margin 93% clear with 11.9 mm margin 97% clear with 12.3 mm margin |
Median 30 months (range 12–58) | 0% |
| Moyer [37] | Retrospective database review, single institution | 564 | No | Head/neck: 564 (100%) | Mean clearance margin 9.3 mm (SD 5.1) | Median 9.3 years |
1.4% 5 years 1.8% 7.5 years 2.2% 10 years |
| Beveridge [40] | Retrospective chart review, single center | 24 | Yes; LM only | Not indicated | Mean clearance margin, 9 mm | Median 18 months (range 1–63) | 0% |
| Wide local excision | |||||||
| Duffy [43] | Retrospective database review, two institutions | 36 | Yes; MIS only |
Trunk: 16 (44%) Extremity: 17 (47%) Foot: 3 (8%) |
Average excision margin 3.8 mm (range 0.2–6.5) Average margin of clearance 4.38 mm (range 1.3–7.75) |
Median 6.6 years (range 0.5–18) | 0% |
| Akhtar [44] | Retrospective database review, single institution | 192 |
Yes; LM: 75 (38%) MIS: 117 (62%) |
Head/neck: 83 (43%) Trunk: 42 (22%) Extremity: 42 (22%) |
Average primary excision margin for narrow excision group 1.51 mmb Average primary excision margin for wider excision group 4 mm |
Mean 31 months (narrow excision); mean 32.6 months (wide excision) |
1.4% (narrow excision) 1.1% (wide excision) 29% (incomplete excision) |
| Welch [42] | Retrospective chart review, two institutions | 155 | Yes; MIS only |
Trunk: 81 (52%) Extremity: 74 (48%) |
100% clear 5 mm margins | Mean 4 years (range 0.25–13) | 0% |
| Blank [70] | Retrospective chart review, single center | 86 | No |
Head/neck: 42 (46%)a Trunk/extremity: 45 (49%) Hand/foot: 1 (1%) Other: 3 (4%) |
Average margin 6.5 ± 2.4 mm | WLE | NR |
| Crouch [45] | Retrospective database review, single institution | 382 | Yes; LM only | Head/neck: 382 (100%) | 91.6% histologically clear with mean surgical margin 6.2 mm ± 3.1 mm | Median 32 months (range 12–223) | 9.9%c |
MIS melanoma in situ, LM lentigo maligna, MMS Mohs micrographic surgery, NR not recorded, SE staged excision, WLE wide local excision, SD standard deviation
aReported for entire cohort, including invasive melanomas
bExcision prior to change in 2006 UK melanoma guidelines that increased the recommended margin to 2–5 mm
cIncluded 11 cases with incomplete histologic excision after initial surgical excision