A retrospective cohort study conducted by Dessinioti et al and published in JAMA Dermatology found that, in cases of melanoma in situ, diagnostic excisional biopsy achieving clear margins may be sufficient for treatment.
“No local recurrences, metastasis, or melanoma-specific death were observed among patients with histologically clear margins treated with initial excisional biopsy alone or via wide excision,” the investigators added. “However, larger studies are necessary.”
Study Details
The investigators focused on 401 patients (female: 53.4%; median age = 52 years) with 403 non–lentigo maligna or non–acral lentiginous melanoma in situ lesions who were diagnosed between 1991 and 2023 and followed up for at least 1 year. Exclusion criteria included a history of invasive melanoma or a histologic diagnosis of lentigo maligna or acral lentiginous melanoma in situ.
Melanoma in situ was most often found on the trunk (49.9%), followed by the lower extremities (24.6%), upper extremities (17.6%), and head and neck (7.9%). All lesions were initially managed with excisional biopsy, followed by wide excision in 92.3% of cases.
Local recurrence, metastasis, and melanoma-specific survival were evaluated as the primary outcomes. Follow-up data were provided for a median of 5.2 years.
Key Findings
The sole case of local recurrence occurred in a patient with involved margins at excisional biopsy who did not undergo a wide excision, ultimately developing invasive melanoma 14 months later. A total of 30 lesions in 30 patients demonstrated clear excisional biopsy margins without wide excision and no recurrence at a median follow-up of 8.1 years. At a median follow-up of 4.3 years, no recurrences were found in 23 patients with 23 lesions that had wide excision with narrower than the standard 0.5-cm margins (mean [standard deviation] = 0.36 [0.07] cm). Lesions suspicious for recurrence were observed near the excision scar in six patients (1.5%) during follow-up; all were excised, and histopathology confirmed diagnoses of nevus or solar lentigo. No patients experienced metastasis or melanoma-specific death.
“These findings provide support that non–lentigo maligna/non–acral lentiginous melanoma in situ excised with clear histopathologic margins in the excisional biopsy may not require additional treatment,” the investigators concluded. “However, our findings should be confirmed with prospective, randomized trials and large multicenter retrospective studies that compare standard management with initial excisional biopsy with clear margins only.”
Clio Dessinioti, MD, of Andreas Sygros Hospital, Athens, is the corresponding author of the JAMA Dermatology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
