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    Don't undertreat margins of primary melanoma

    Following American Academy of Dermatology (AAD) guidelines for primary cutaneous melanoma helps ensure consistent outcomes, an expert said Friday at the 74th Annual Meeting of the American Academy of Dermatology in Washington D.C.

    READ: Melanoma treatment:Surgery is not obsolete

    Current AAD melanoma guidelines recommend narrow excisional biopsy that encompasses the entire breadth of the lesion, with margins sufficient to ensure the lesion is not transected.Physicians may accomplish this with elliptical or punch excisions with sutures, or with disk ("scoop") excisions, the guidelines add. And partial sampling is acceptable in certain cases, such as with large tumors, tumors in facial or acral locations, and tumors with a low degree of suspicion or little clinical uncertainty.

    Hensin Tsao, M.D.Hensin Tsao, M.D., Ph.D.When biopsying suspicious pigmented lesions, Hensin Tsao, M.D., Ph.D., says "Try to remove the entire lesion so that no cryptic focus of melanoma remains. With either fusiform excision or disk excision, the goal is to remove the entire lesion for analysis. In terms of the definitive, or wide, resection, there might be a gap there — people might still be undertreating some melanomas in terms of margins." Dr. Tsao is professor of dermatology at Harvard Medical School and director of the Melanoma and Pigmented Lesion Center/Department of Dermatology at Massachusetts General Hospital.

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    AAD guidelines recommend margins of 0.5 to 1.0 cm for melanoma in situ; 1 cm for tumors ≤ 1.0 mm thick; 1 to 2 cm for lesions 1.01 to 2.0 mm thick; and 2 cm for lesions > 2.0 mm thick. "These guidelines are consistent with guidelines recommended by other organizations such as the National Comprehensive Cancer Network. The overall goal is to have more uniform guidelines."

    Ultimately, Dr. Tsao says, biopsy success rests less on the type of biopsy than the expertise of the physician.

    "A skilled dermatologist can usually remove the entire lesion through any number of means,” he says. “However, if you're trying to clear the melanoma lesion but technically your margins are always less than the 2 to 3 mm recommended removal margin, there’s a greater likelihood that you will bump into the tumor's edge. If we were all trained properly, results would be more uniform."

    NEXT: Margin data

    John Jesitus
    John Jesitus is a medical writer based in Westminster, CO.

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