Disadvantages of Excision for Melanoma
Source: Dermatology Times, October 2022
At the Melanoma Update of the Annual ASDS Meeting, Tyler Hollmig, MD, looked at complex clinical scenarios when treating melanoma and the continued challenges dermatologists face.
To begin his updates on treatment methods for melanoma, Tyler Hollmig, MD, director of dermatologic surgery in the department of internal medicine at the University of Texas at Austin Dell Medical School in Austin, Texas, reiterated that the incidence of melanoma has risen substantially over the last few decades. According to Hollmig, lifetime risk now is over one in 50. Traditionally, melanoma is treated by excision with a recommended margin of healthy-appearing skin. The specimen is then fixed in formalin and vertically sectioned, like a bread loaf. The sections allow for visualization and staging of the central tumor. But Hollmig also states that excisional surgery is not perfect, it has disadvantages as well.
Hollmig points out 4 major disadvantages of excisional surgery. First, traditional excision does not completely examine the margin, which creates an increased risk of false negative margins. Most pathologists will cut sections about every 3 to 4 millimeters, which studies show allows pathologists to visualize approximately 25% of the margin. To see all of the margin using cut sections, pathologists would have to cut at .01 millimeter increments, which is impossible, according to Hollmig.