Browsing by Author "Rossi, A. M."

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    Incompletely excised lentigo maligna melanoma is associated with unpredictable residual disease: clinical features and the emerging role of reflectance confocal microscopy
    (2020) Navarrete-Dechent, C.; Aleissa, S.; Cordova, M.; Liopyris, K.; Lee, E. H.; Rossi, A. M.; Hollman, T.; Pulitzer, M.; Lezcano, C.; Busam, K. J.; Marghoob, A. A.; Chen, C-C J.; Nehal, K. S.
    Background Lentigo maligna/lentigo maligna melanoma (LM/LMM) poses a treatment and surgical challenge given unpredictable subclinical extension resulting in incomplete excision. Objectives To describe the demographic, clinical and pathologic characteristics of incompletely excisedLM/LMM. To evaluate the potential role of reflectance confocal microscopy (RCM). Patients and methods A retrospective review of a melanoma database at a tertiary cancer centre for patients referred with 'incompletely excisedLM/LMM' or 'incompletely excised melanoma' between October 2006 and July 2017. We recorded clinical and pathological data and surgical margins needed to clear the residualLM/LMM. The second part consisted of a prospective cohort of patients in whichRCMwas performed when presenting with incompletely excisedLM/LMM. Results We included a total of 67 patients (retrospective + prospective cohort); mean age was 64.9 (standard deviation: 11.3) years and 52.2% were males. For the retrospective cohort (n = 53), the mean scar size was 3.4 cm. The average initial margins excised prior to presentation were 4.8 mm (range 3-7 mm). The average additional margin needed to clear the residual, incompletely excisedLM/LMMwas 7.8 mm. For the prospective cohort (n = 14), there were no differences in age, gender or size when compared to the retrospective cohort.RCMhad a diagnostic accuracy of 78.6%, a sensitivity of 90.9%, a specificity of 33.3% and a positive predictive value of 83.3% for the detection of incompletely excisedLM/LMM. Conclusions Incompletely excisedLM/LMMis a poorly characterized clinical-pathological scenario that may require considerable extra margins for microscopic clearance.RCMmay emerge as a valuable tool for the evaluation of patients with incompletely excisedLM/LMM.