Histologic margin status is a predictor of relapse in lentigo maligna melanoma

Mai P Hoang; Pawel Karpinski; Miguel Zúñiga-Castillo; Ruth K Foreman; Kevin S Emerick; Arthur J Sober

doi:10.1016/j.jaad.2023.07.008

Histologic margin status is a predictor of relapse in lentigo maligna melanoma

J Am Acad Dermatol. 2023 Nov;89(5):959-966. doi: 10.1016/j.jaad.2023.07.008. Epub 2023 Jul 14.

Authors

Mai P Hoang¹, Pawel Karpinski², Miguel Zúñiga-Castillo³, Ruth K Foreman³, Kevin S Emerick⁴, Arthur J Sober⁵

Affiliations

¹ Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: mhoang@mgh.harvard.edu.
² Department of Genetics, Wroclaw Medical University, Wroclaw, Poland; Laboratory of Genomics and Bioinformatics, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland.
³ Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
⁴ Department of Surgery, Massachusetts Eye and Ear Institute and Harvard Medical School, Boston, Massachusetts.
⁵ Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.

PMID: 37454699
DOI: 10.1016/j.jaad.2023.07.008

Abstract

Background: Most surgical margins for lentigo maligna melanomas reported in the literature are clinical and not histologic.

Objectives: We sought to determine whether histologic margin status is an independent predictor of progression.

Methods: Clinicopathologic information of 268 invasive lentigo maligna melanomas diagnosed from 1990-2019 were analyzed. Statistical analyses were performed using Cox proportional hazards model and Boruta method.

Results: A total of 75% of the lesions were located on the head and neck. The range of follow-up for all patients was 0 to 31.8 years (median, 10.2 years). Time to local recurrence ranges from 0 to 20 years (median, 3 years). Progression developed in 54 (20.1%) of 268 patients. Local recurrence was seen only in 36 (13.4%), both local recurrence and subsequent metastasis in 7 (2.6%), and only metastasis in 11 (4.1%) of 268 patients. Histologic margin status (positive and close/<3 mm) and tumor site (head and neck location) significantly correlated with worse progression-free survival.

Limitations: Single institution and retrospective study.

Conclusions: Histologic margin status is the strongest predictor of progression for lentigo maligna melanoma. Patients with positive or close/<3 mm histologic margins should consider a re-excision due to the increased risk of relapse.

Keywords: histology; lentigo maligna; margin; melanoma; metastasis; progression; recurrence.