ABSTRACT
BACKGROUND: Management of primary cutaneous malignant melanoma is with initial excision biopsy followed by a wide local excision to achieve locoregional control. For low-risk thin melanomas, the added survival benefit from the wide local excision is minimal. In this study, we investigated the morbidities of wide local excision and evaluated the current clinical practice in managing stage IA malignant melanoma. METHODS: Patients with confirmed stage IA malignant melanoma who had undergone a wide local excision in the 2013/14 period were identified using a specialist cancer multidisciplinary team-held database. Primary pathology, surgical data and follow-up documentation were analysed. RESULTS: A total of 231 cases were identified; 95% of patients (n = 220) had malignant melanoma excised completely at first excision biopsy, mean margin 2.8mm (range 0.5-8.0mm). Postoperative morbidities occurred in 25% of patients (n = 57), including 6.6% wound problems, 10.9% scarring problems, 10.0% psychological stress and 0.4% cosmetic concern. Wide local excision reconstructions were performed with primary closure in 82% of patients, split skin grafts in 4%, full-thickness skin grafts in 3% and flaps in 10%. Of the total, 44% of patients (n = 101) had further excisions and 17 received new low-risk melanoma diagnoses. CONCLUSIONS: We demonstrated that 1cm wide local excision is associated with significant morbidity, which can affect patients' physical, psychological and social wellbeing. Since wide local excision does not give a survival advantage, and its margin is already frequently reduced in cosmetically sensitive areas, the need for a second full 1cm wide local excision procedure for thin melanoma should be re-evaluated, especially when 95% of our study cohort had their malignant melanoma completely excised by the initial biopsy alone.
Subject(s)
Margins of Excision , Melanoma/surgery , Neoplasm Staging , Plastic Surgery Procedures/methods , Skin Neoplasms/surgery , Surgical Flaps , Adolescent , Adult , Aged , Aged, 80 and over , Biopsy , Female , Follow-Up Studies , Humans , Male , Melanoma/diagnosis , Middle Aged , Retrospective Studies , Skin Neoplasms/diagnosis , Treatment Outcome , Young Adult , Melanoma, Cutaneous MalignantABSTRACT
Congenital craniofacial dermoid cysts are hamartomas of ectodermal and mesodermal origin, made up of keratinizing epithelium lining a cavity containing dermal skin appendages. They usually present as an asymptomatic, firm, round mass, usually noticed at birth or in the first year. They are thought to occur as a result of ectodermal sequestration at lines of fusion during embryological development. Although nasal and epibulbar dermoid cysts have occurred in families and have been associated with inheritable gene defects, there has previously been no evidence for a similar etiology in external angular cases. We present the first description of external angular dermoids occurring in siblings suggesting that this subgroup may, in some instances, also have a genetic origin.