Frequency of and factors associated with positive or equivocal margins in conventional excision of atypical intraepidermal melanocytic proliferations (AIMP): A single academic institution cross-sectional study

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• 作者：Junqian Zhang ; BS^a ; Christopher J. Miller ; MD^b ; Joseph F. Sobanko ; MD^b ; Thuzar M. Shin ; MD ; PhD^b ; Jeremy R. Etzkorn ; MD^b ; ^{jeremy.etzkorn@uphs.upenn.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：atypical intraepidermal melanocytic proliferation ; excision ; melanoma ; Mohs ; positive margin ; surgery
• 刊名：Journal of the American Academy of Dermatology
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：75
• 期：4
• 页码：688-695
• 全文大小：157 K

文摘

No evidence-based surgical guidelines exist for atypical intraepidermal melanocytic proliferation (AIMP), a descriptive histopathologic diagnosis with uncertain malignant potential.

Objective

We sought to identify the frequency of and risk factors associated with positive or equivocal margins after conventional excision.

Methods

We conducted a retrospective cross-sectional study of 413 AIMPs treated by conventional excision.

Results

Positive or equivocal margins were seen in 2.9% (12/413) of conventional excisions of AIMP. Risk factors associated with positive or equivocal margins included anatomic location on the head and neck (5/51, 9.8%; odds ratio 6.91, 95% confidence interval 1.93-24.80) (P = .012) and a preoperative biopsy specimen that included melanoma in situ in the differential diagnosis (11/214, 5.1%; odds ratio 10.73, 95% confidence interval 1.37-83.88) (P = .006). The frequency of positive or equivocal margins did not differ significantly with surgical margins greater than or less than 5 mm (odds ratio 0.61, 95% confidence interval 0.18-2.07) (P = .457).

Limitations

This was a single-site, retrospective observational study.

Conclusion

AIMP has a significantly increased risk for incomplete excision when it is located on the head and neck or has a preoperative histologic differential diagnosis that includes melanoma in situ. These subsets of AIMP may benefit from Mohs micrographic surgery or staged surgical excision to confirm clear margins before reconstruction.