PMID- 31490196
STAT- Publisher
LR  - 20190906
IS  - 1533-0311 (Electronic)
IS  - 0193-1091 (Linking)
DP  - 2019 Aug 29
TI  - "Personalized Excision" of Malignant Melanoma-Need for a Paradigm Shift in the
      Beginning Era of Personalized Medicine.
LID - 10.1097/DAD.0000000000001450 [doi]
AB  - The premises on which guidelines for the excision of primary cutaneous melanoma
      are based are illogical and fail to take into account peculiarities of the
      individual lesion. The horizontal margins of excision continue to be adjusted to 
      the vertical thickness of the neoplasm, and recommended clinical margins do not
      reflect the histopathologic borders of melanoma. Micrographically controlled
      surgery has become accepted for acral melanomas and melanomas of the face and
      neck but not for melanomas on the trunk, arms, and legs, although the latter tend
      to be more sharply confined. Extending margins of excision for the purpose of
      removing inapparent metastases is fallacious because the latter are rare, their
      localization cannot be foretold, and satellite metastases are usually associated 
      with distant metastases, so that patients do not profit from early removal of
      cutaneous lesions. The only meaningful objective of excision is complete removal 
      of the primary melanoma. The success of excision must be controlled
      histopathologically. Because of limitations of the method, a histopathologic
      safety margin should be observed that must depend on the characteristics of the
      individual lesion. In sharply confined melanomas, a histopathologic margin of at 
      least 1 mm is sufficient. In the case of poor demarcation, with solitary atypical
      melanocytes extending far beyond the bulk of the lesion, a broader
      histopathologic safety margin is advisable. Special caution should be exercised
      in the presence of regression and for desmoplastic melanomas, acral melanomas,
      and melanomas on the face and scalp. Instead of wide and deep excisions with
      standardized margins, "personalized excisions" are required for primary cutaneous
      melanoma. The concept of clinical safety margins is a relic of former times that 
      has no place in modern medicine.
FAU - Weyers, Wolfgang
AU  - Weyers W
AD  - Center for Dermatopathology, Freiburg, Germany.
LA  - eng
PT  - Journal Article
DEP - 20190829
PL  - United States
TA  - Am J Dermatopathol
JT  - The American Journal of dermatopathology
JID - 7911005
SB  - IM
EDAT- 2019/09/07 06:00
MHDA- 2019/09/07 06:00
CRDT- 2019/09/07 06:00
PHST- 2019/09/07 06:00 [entrez]
PHST- 2019/09/07 06:00 [pubmed]
PHST- 2019/09/07 06:00 [medline]
AID - 10.1097/DAD.0000000000001450 [doi]
PST - aheadofprint
SO  - Am J Dermatopathol. 2019 Aug 29. doi: 10.1097/DAD.0000000000001450.