Publication date: Apr 15, 2025
The strength of evidence supporting a 2-step wide local excision (WLE) with 5 mm safety margins for melanoma in situ non-lentigo maligna (non-LM) type, compared with narrower margins, is unclear. This review aims to compare the frequency of local recurrence (LR) with different safety margins, after the complete surgical excision (R0) of non-LM MIS. We performed a systematic literature search in PubMed, Scopus, and the Cochrane Library up to March 17, 2024. The PRISMA checklist was used. Of 3,047 articles retrieved, seven retrospective studies were included, enrolling a total of 1,526 non-LM MIS cases excised with clear safety margins, after WLE (6 studies) or Mohs surgery (1 study). Most non-LM MIS were located on the trunk/extremities (68%-100%). Narrower margins were used in four studies, ranging from no WLE to 4 mm, and there was only one LR. Standard or wider margins were used in the remaining three studies reporting only two LR. The median follow-up ranged from 48 months to 6. 6 years. The overall certainty and quality of evidence were very low. These findings of our systematic review highlight that current guidelines recommending the re-excision for non-LM MIS with clear initial margins lack strong evidence in support of this practice.
| Concepts | Keywords |
|---|---|
| 48months | death |
| Library | excision |
| Melanoma | margins |
| Retrospective | Melanoma in situ |
| metastasis | |
| recurrence | |
| surgery | |
| systematic review |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | recurrence |
| disease | MESH | lentigo maligna |
| disease | MESH | melanoma |
| pathway | KEGG | Melanoma |
| disease | MESH | death |
| disease | MESH | metastasis |