C M Grin-Jorgensen | PubMed Health

PubMed1992

Verification of a formula for determination of preexcision surgical margins from fixed-tissue melanoma specimens.

BACKGROUND: Recently our group reported on the shrinkage of 199 malignant melanoma surgical-excision specimens. In that report, a multivariate analysis revealed that the age of the patient was the only factor that significantly affected the percentage shrinkage of a surgical specimen. In addition, a formula was presented that extrapolates the actual surgical margins (in vivo) from the (contracted) fixed-tissue pathology report measurement and the reported in vivo lesion diameter. OBJECTIVE: The goals of this study are to verify that shrinkage of surgical specimens is approximately 20% and that the margin formula can be successfully applied to a different group of patients. METHODS: Four hundred seven patients with malignant melanoma were prospectively enrolled to measure preexcision (outlined with ink) surgical margins, fixed-tissue (contracted) surgical margins, and overall specimen shrinkage. RESULTS: It is verified that overall shrinkage of cutaneous surgical specimens is approximately 20%. Surgical specimens from patients younger than 50 years of age have approximately 25% shrinkage. Those specimens from patients 50 to 59 years of age have approximately 20% shrinkage and those from patients 60 years of age or older have about 15% shrinkage. The surgical margins predicted by the margin formula were within +/- 3.5 mm of the actual measured surgical margin 86.5% of the time. CONCLUSION: The actual surgical margins (in vivo) of a malignant melanoma can be reasonably estimated from the fixed-tissue pathology measurement via the margin formula. The shrinkage of a surgical specimen is 15% to 25% depending on the patient's age.

Adolescent↗

PubMed1992

Spitz nevi.

The Spitz nevus has long been defined as a benign melanocytic lesion that shares many histologic features with malignant melanoma. Despite the diagnostic criteria established for these two entities, their histologic similarities continue to make their distinction somewhat difficult. Uncertainties also exist with regard to the natural history of the Spitz nevus; the true pattern of this lesion's biologic behavior remains elusive. As a result, controversies exist with respect to appropriate therapy. To examine these controversies, the epidemiology, clinical features, and histopathology of Spitz nevi, as well as the role of recent molecular and immunohistochemical diagnostic studies, are discussed. However, the primary focus of this article is the natural course, prognosis, and treatment of the Spitz nevus. A review of 716 cases of Spitz nevi, compiled from 13 papers published from 1948 to 1990, is presented. After analyzing this and other available data, we propose that at this time Spitz nevi and malignant melanoma cannot easily be categorized as distinct entities and that perhaps they actually exist along one continuum of disease. Because of this uncertainty and the difficulties in differentiating these two lesions, we recommend that treatment include complete excision of all Spitz nevi followed by reexcision of positive margins if present.

Diagnosis, Differential↗