1
|
Sahu K, Sirka CS, Sethy M, Mishra J. Unilateral nodular malignant melanoma with in-transit metastasis over lower limb masquerading as vascular tumours: A unique presentation. Indian J Dermatol Venereol Leprol 2022; 89:446-449. [PMID: 36688882 DOI: 10.25259/ijdvl_568_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 11/01/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Kananbala Sahu
- Department of Dermatology, Sri Jagannath Medical College and Hospital, Puri, Odisha, India
| | - Chandra Sekhar Sirka
- Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Madhusmita Sethy
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Jeebanjyoti Mishra
- Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| |
Collapse
|
2
|
Zhang S, McClanahan D, Khosravi H, Ferris LK. Screening and Managing Melanoma: Who Is (Should Be) Doing It? CURRENT DERMATOLOGY REPORTS 2019. [DOI: 10.1007/s13671-019-00268-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
3
|
Kueder-Pajares T, Descalzo M, García-Doval I, Ríos-Buceta L, Moreno-Ramírez D. Evaluación de indicadores de estructura en la atención al paciente con cáncer de piel en los servicios de dermatología. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:807-812. [DOI: 10.1016/j.ad.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/20/2018] [Accepted: 06/03/2018] [Indexed: 11/24/2022] Open
|
4
|
Kueder-Pajares T, Descalzo M, García-Doval I, Ríos-Buceta L, Moreno-Ramírez D. Evaluation of Structure Indicators for Assessing Skin Cancer Quality of Care in Dermatology Departments. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
5
|
Look Hong NJ, Cheng SY, Baxter NN, Wright FC. Melanoma patterns of care in Ontario: A call for a strategic alignment of multidisciplinary care. J Surg Oncol 2018; 117:597-617. [PMID: 29228470 DOI: 10.1002/jso.24936] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 11/02/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Variability in melanoma management has prompted concerns about equitable and timely treatment. We investigated patterns of melanoma diagnosis and treatment using population-level data. METHODS Patients with invasive cutaneous melanoma were identified retrospectively from the Ontario Cancer Registry (2003-2012) and deterministically linked with administrative databases to identify incidence, disease characteristics, geographic origin, and multimodal treatment within a year of diagnosis. Melanoma treatment was categorized as inadequate or adequate based on multidisciplinary clinical algorithms. Multivariable logistic regression was used to model factors associated with treatment adequacy. RESULTS From 2003 to 2012, 22 918 patients with invasive melanoma were identified with annual age/sex standardized incidence rates of 11.7-14.3/100 000 for females and 13.4-15.9/100 000 for males. Melanoma occurred at median age of 62 and primarily on extremities (43.9%). Within 1 year after diagnosis, 86.7% of patients received surgery as primary therapy. A total of 2312 (10.6%) patients received inadequate or no treatment after diagnosis. Receiving adequate treatment was associated with consultation with dermatology (OR 1.92, CI 1.71-2.14), plastic surgery (OR 4.80, CI 4.32-5.34), or general surgery (OR 2.15, CI 1.94-2.38). CONCLUSIONS Significant variation exists in melanoma management and nearly one in nine patients is inadequately treated. Referral to sub-specialized providers is critical for ensuring appropriate care.
Collapse
Affiliation(s)
- Nicole J Look Hong
- Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontorio, Canada
| | - Stephanie Y Cheng
- Institute for Clinical Evaluative Sciences, Toronto, Ontorio, Canada
| | - Nancy N Baxter
- Institute for Clinical Evaluative Sciences, Toronto, Ontorio, Canada
- St. Michael's Hospital, Department of Surgery and Keenan Research Centre, Toronto, Ontorio, Canada
| | - Frances C Wright
- Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontorio, Canada
| |
Collapse
|
6
|
Carlquist E, Lee NE, Shalin SC, Goodman M, Gardner JM. Dermatopathology and Social Media: A Survey of 131 Medical Professionals From 29 Countries. Arch Pathol Lab Med 2017; 142:184-190. [PMID: 28657771 DOI: 10.5858/arpa.2017-0064-oa] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Use of social media in the medical profession is an increasingly prevalent and sometimes controversial practice. Many doctors believe social media is the future and embrace it as an educational and collaborative tool. Others maintain reservations concerning issues such as patient confidentiality, and legal and ethical risks. OBJECTIVE - To explore the utility of social media as an educational and collaborative tool in dermatopathology. DESIGN - We constructed 2 identical surveys containing questions pertaining to the responders' demographics and opinions regarding the use of social media for dermatopathology. The surveys were available on Twitter and Facebook for a period of 10 days. RESULTS - The survey was completed by 131 medical professionals from 29 different countries: the majority (81%, 106 of 131) were 25 to 45 years of age. Most replied that they access Facebook or Twitter several times a day (68%, 89 of 131) for both professional and social purposes (77%, 101 of 131). The majority agreed that social media provides useful and relevant information, but stated limitations they would like addressed. CONCLUSIONS - Social media is a powerful tool with the ability to instantaneously share dermatopathology with medical professionals across the world. This study reveals the opinions and characteristics of the population of medical professionals currently using social media for education and collaboration in dermatopathology.
Collapse
|
7
|
Moyer JS. The Increasing Incidence of Melanoma: It May Be More Than a Freckle. JAMA FACIAL PLAST SU 2017; 19:62-63. [PMID: 27606435 DOI: 10.1001/jamafacial.2016.1044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Michigan, Ann Arbor
| |
Collapse
|
8
|
Dandekar M, Lowe L, Fullen DR, Johnson TM, Sabel MS, Wong SL, Patel RM. Discordance in Histopathologic Evaluation of Melanoma Sentinel Lymph Node Biopsy with Clinical Follow-Up: Results from a Prospectively Collected Database. Ann Surg Oncol 2014; 21:3406-11. [DOI: 10.1245/s10434-014-3773-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Indexed: 11/18/2022]
|
9
|
Santillan AA, Messina JL, Marzban SS, Crespo G, Sondak VK, Zager JS. Pathology Review of Thin Melanoma and Melanoma in Situ in a Multidisciplinary Melanoma Clinic: Impact on Treatment Decisions. J Clin Oncol 2010; 28:481-6. [DOI: 10.1200/jco.2009.24.7734] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose Patients with thin melanoma (≤ 1.0 mm) and melanoma in situ (MIS) represent the majority of newly diagnosed melanoma. We estimated the impact of expert review of outside pathology material on the staging and thus treatment decisions affecting patients referred to a multidisciplinary clinic with early-stage melanoma. Patients and Methods We studied patients with a diagnosis of thin melanoma or MIS referred to H. Lee Moffitt Cancer Center from 2006 to 2009. After comparing the referring laboratory and in-house dermatopathologic interpretations, we calculated any differences in diagnosis and tumor staging and the potential impact of differences in diagnosis and staging on prognosis and surgical treatment using the National Comprehensive Cancer Network clinical guidelines. Results The overall pathologic discordance rate in diagnosis was 4% (15 of 420 patients; 95% CI, 2% to 6%). The overall change in tumor staging rate was 24% (97 of 405 patients; 95% CI, 20% to 28%). Pathology review led to changes in surgical excision margins in 12% of patients (52 of 420 patients; 95% CI, 9% to 16%) and in the decision about whether to perform a sentinel lymph node biopsy in 16% of patients (67 of 420 patients; 95% CI, 13% to 20%). Key pathologic factors, particularly mitotic rate, were frequently missing from outside pathology reports. Conclusion Our data suggest that review of thin melanoma or MIS by an expert dermatopathologist results in frequent, clinically meaningful alterations in diagnosis, staging, prognosis, and surgical treatment. Referral of these patients to a multidisciplinary melanoma clinic is appropriate, and management of such patients should include review of the biopsy whenever feasible.
Collapse
Affiliation(s)
- Alfredo A. Santillan
- From the Department of Surgery, Section of Surgical Oncology, University of Texas Health Science Center at San Antonio; Section of Surgical Oncology, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute; and Departments of Oncologic Sciences, Dermatology, and Surgery, University of South Florida College of Medicine, Tampa, FL
| | - Jane L. Messina
- From the Department of Surgery, Section of Surgical Oncology, University of Texas Health Science Center at San Antonio; Section of Surgical Oncology, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute; and Departments of Oncologic Sciences, Dermatology, and Surgery, University of South Florida College of Medicine, Tampa, FL
| | - Suroosh S. Marzban
- From the Department of Surgery, Section of Surgical Oncology, University of Texas Health Science Center at San Antonio; Section of Surgical Oncology, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute; and Departments of Oncologic Sciences, Dermatology, and Surgery, University of South Florida College of Medicine, Tampa, FL
| | - Gema Crespo
- From the Department of Surgery, Section of Surgical Oncology, University of Texas Health Science Center at San Antonio; Section of Surgical Oncology, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute; and Departments of Oncologic Sciences, Dermatology, and Surgery, University of South Florida College of Medicine, Tampa, FL
| | - Vernon K. Sondak
- From the Department of Surgery, Section of Surgical Oncology, University of Texas Health Science Center at San Antonio; Section of Surgical Oncology, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute; and Departments of Oncologic Sciences, Dermatology, and Surgery, University of South Florida College of Medicine, Tampa, FL
| | - Jonathan S. Zager
- From the Department of Surgery, Section of Surgical Oncology, University of Texas Health Science Center at San Antonio; Section of Surgical Oncology, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute; and Departments of Oncologic Sciences, Dermatology, and Surgery, University of South Florida College of Medicine, Tampa, FL
| |
Collapse
|
10
|
Abstract
Recognizing early forms of melanoma may have significant impact on decreasing mortality from this malignancy. As a result, multiple efforts have focused on developing new and improving current early detection strategies. These include educating patients about the importance of performing skin self-examination, increasing rates of complete skin examinations by physicians in the context of routine care, initiating mass screening campaigns, creating specialized skin cancer clinics, and developing better diagnostic tools through advances in technology. In this article, the current state of these efforts is reviewed.
Collapse
Affiliation(s)
- Vitaly Terushkin
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 160 East 53rd Street, New York, NY 10022, USA
| | | |
Collapse
|
11
|
Bichakjian CK, Lowe L, Lao CD, Sandler HM, Bradford CR, Johnson TM, Wong SL. Merkel cell carcinoma: critical review with guidelines for multidisciplinary management. Cancer 2007; 110:1-12. [PMID: 17520670 DOI: 10.1002/cncr.22765] [Citation(s) in RCA: 229] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Merkel cell carcinoma (MCC) is a relatively rare cutaneous malignancy that occurs predominantly in the older white population. The incidence of MCC appears to have tripled during the past 20 years; an increase that is likely to continue because of the growing number of older Americans. The pathogenesis of MCC remains largely unknown. However, ultraviolet radiation and immunosuppression are likely to play a significant pathogenetic role. Many questions currently remain unanswered regarding the biologic behavior and optimal treatment of MCC. Large, prospective, randomized studies are not available and are unlikely to be performed because of the rarity of the disease. The objective of this review was to provide a comprehensive reference for MCC based on a critical evaluation of the current data. The authors investigated the importance of sentinel lymph node biopsy as a staging tool for MCC to assess the status of the regional lymph node basin and to determine the need for additional therapy to the lymph node basin. In an attempt to standardize prospective data collection with the intention to define prognostic indicators, the authors also present histopathologic profiles for primary MCC and sentinel lymph nodes. The controversies regarding the appropriate surgical approach to primary MCC, the use of adjuvant radiation therapy, and the effectiveness of adjuvant chemotherapy were examined critically. Finally, the authors have provided treatment guidelines based on the available evidence and their multidisciplinary experience.
Collapse
Affiliation(s)
- Christopher K Bichakjian
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan 48109-0314, USA.
| | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW Early diagnosis has the greatest potential for short-term impact on melanoma mortality. We highlight recent trends in early melanoma detection and address the related challenges and opportunities. RECENT FINDINGS Significant strides have been made in the early diagnosis of melanoma. Success has been achieved through improved awareness of early signs of melanoma and identification of high-risk cohorts. Detection pressure, however, may also be resulting in the diagnosis of indolent disease, leading to unnecessary morbidity and cost. A looming imbalance of supply and demand for melanoma detection services is anticipated with the aging of the baby boom generation. Prioritization of other preventive services and a growing emphasis on cosmetic dermatology are anticipated to exacerbate this imbalance. While a paucity of hard data have precluded adoption of formal screening recommendations for melanoma, general consensus supports opportunistic screening and identification of high-risk individuals who may benefit from specialized surveillance with dermoscopy and whole-body photography. Research is needed to distinguish biologically indolent and aggressive melanoma, to develop and test evolving technologies to aid diagnosis, and to assess the utility of specific public health strategies for melanoma detection. SUMMARY Significant strides have been made in early melanoma detection, but multiple challenges remain.
Collapse
Affiliation(s)
- Allan C Halpern
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | |
Collapse
|
13
|
Stitzenberg KB, Thomas NE, Ollila DW. Influence of provider and practice characteristics on melanoma care. Am J Surg 2007; 193:206-12. [PMID: 17236848 DOI: 10.1016/j.amjsurg.2006.06.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Revised: 09/27/2006] [Accepted: 06/15/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND Melanoma care is becoming increasingly multidisciplinary, requiring coordination of many types of providers. The purpose of this study is to describe the structure of melanoma care in North Carolina by examining services provided by different providers and the overall coordination of care. METHODS Self-administered surveys were developed to collect demographic and practice information, assess patient volume and services provided, and explore referral patterns. Surveys were administered to all dermatologists and a subset of surgeons practicing in North Carolina. RESULTS The response rate was 60% (263/438). Melanoma patient volume, referral patterns, use of nodal staging, and access to clinical trials were each related to provider characteristics, specialty, affiliations with cancer care organizations, and practice setting. CONCLUSIONS Many types of providers contribute significantly to the care of melanoma patients. Coordination between providers is variable. This study provides indirect evidence that multidisciplinary melanoma programs increase patient access to comprehensive melanoma care.
Collapse
Affiliation(s)
- Karyn B Stitzenberg
- Department of Surgery, University of North Carolina, 3010 Old Clinic Building, CB# 7213, Chapel Hill, NC 27599-7213, USA.
| | | | | |
Collapse
|
14
|
Wang SQ, Halpern AC. Management of Cutaneous Melanoma: A Public Health and Individual Patient Care Perspective. ACTA ACUST UNITED AC 2007; 23:81-98. [DOI: 10.1016/j.yadr.2007.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
|
16
|
Chao MM, Schwartz JL, Wechsler DS, Thornburg CD, Griffith KA, Williams JA. High-risk surgically resected pediatric melanoma and adjuvant interferon therapy. Pediatr Blood Cancer 2005; 44:441-8. [PMID: 15468307 DOI: 10.1002/pbc.20168] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Pediatric patients with high-risk surgically resected melanoma are at risk for relapse, yet little is known about these young patients and how they tolerate high-dose interferon therapy. PROCEDURE We reviewed medical records of patients (< or =18 years) with high-risk melanoma referred to the University of Michigan Pediatric Hematology-Oncology service between January 1989 and July 2003. RESULTS Fourteen patients were identified with high-risk resected melanoma. The median age at diagnosis was 8.5 years. The median time to establish diagnosis was 9 months. Primary lesions were diagnosed as unequivocal melanoma, atypical epithelioid melanocytic proliferations, or atypical Spitz tumor with indeterminate malignant potential. Twelve patients had a positive sentinel lymph node (SLN) biopsy or a palpable regional lymph node and underwent regional lymph node dissection (LND). Two patients with unequivocal melanoma with Breslow depth >4 mm had negative SLN biopsies. Twelve patients received adjuvant high-dose interferon. The following toxicities were observed: constitutional symptoms, gastrointestinal symptoms, depression or neuropsychiatric symptoms, myelosuppression, elevated AST or ALT, hypothyroidism, and hypertension. Grade 3 or 4 toxicities were uncommon with exception of neutropenia, resulting in modification of therapy in one patient. All patients are alive and free of disease at follow-up (median 24.5 months). CONCLUSIONS Invasive melanoma can occur in very young children. Despite early signs of malignancy, there is often a delay in diagnosis. Histologically, diagnosis may be difficult because of overlap with Spitz nevi. Pediatric patients tolerated adjuvant high-dose interferon well and may be less likely than adults to require therapy modification secondary to toxicities.
Collapse
Affiliation(s)
- Mwe Mwe Chao
- Department of Pediatric Hematology-Oncology, University of Michigan Health System, Ann Arbor, Michigan 48109-0936, USA.
| | | | | | | | | | | |
Collapse
|
17
|
Wechter ME, Reynolds RK, Haefner HK, Lowe L, Gruber SB, Schwartz JL, Johnston CM, Johnson TM. Vulvar Melanoma: Review of Diagnosis, Staging, and Therapy. J Low Genit Tract Dis 2004; 8:58-69. [PMID: 15874838 DOI: 10.1097/00128360-200401000-00012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To update, assimilate, and bridge the contemporary literature on vulvar and cutaneous melanoma regarding diagnosis, staging, and therapy to provide a useful clinical reference for managing and counseling for affected patients. MATERIALS AND METHODS A computerized search for reports in the literature up to June 2003 was carried out using PubMed and MEDLINE databases. Multidisciplinary involvement was used in evaluating the available data and formulating conclusions. RESULTS More than 300 reports were reviewed. Diagnosis, staging, and therapy aspects of vulvar melanoma are summarized. CONCLUSIONS Vulvar melanoma represents a subtype of cutaneous melanoma, with similar prognostic and staging factors. The most recent American Joint Committee on Cancer staging system for cutaneous melanoma is applicable to vulvar melanoma. Sentinel lymph node biopsy is reliable for staging the regional lymph node basin for vulvar melanoma. Standardized documentation of clinical and histopathologic parameters is needed to standardize grouping of cases for future comparison studies.
Collapse
Affiliation(s)
- Mary Ellen Wechter
- Department of Obstetrics and Gynecology, University of Michigan Health System, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109-0314, USA
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Barzilai DA, Singer ME. The potential impact on melanoma mortality of reducing rates of suboptimal excision margins. J Invest Dermatol 2003; 120:1067-72. [PMID: 12787136 DOI: 10.1046/j.1523-1747.2003.12240.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We estimated the potential benefit of reducing rates of inadequate excision margins in the treatment of localized invasive melanoma. A computer-simulated Markov decision analytic model was created to follow until death a hypothetical cohort of 55 y old Caucasians, newly diagnosed in a community setting with localized invasive melanoma. We considered two scenarios: usual care, and a hypothetical intervention. Markov states included well without local recurrence, local recurrence, cured, and dead. Published population-based data were used for rates of optimal excision margins, local recurrence, and mortality. Two outcome measures were employed: melanoma-related mortality and life expectancy. Major assumptions included: local recurrence occurs within 10 y of diagnosis, and patients revert to general population mortality rates 10 y following melanoma excision or subsequent local recurrence. For usual care, the model estimated 8.17% melanoma-related mortality. Modeling intervention with 100% optimal excision margins reduced this rate to 6.15%, a 25% relative reduction in mortality. This increased average life expectancy by 0.437 y, which equates to approximately 11 additional years in the 4% who would not experience a local recurrence due to improved excision margins. Increasing the percentage of optimal excision margins to 80% would still yield substantial improvement, with 6.83% melanoma-related mortality, saving 0.29 life-years compared with baseline. Results were insensitive to moderate changes in the parameter values. Suboptimal excision margins may account for approximately one-fourth of all melanoma-related mortality for localized invasive melanoma. If intervention can achieve even modest adherence to optimal excision margins, it might substantially reduce mortality.
Collapse
Affiliation(s)
- David A Barzilai
- Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA
| | | |
Collapse
|