Melanoma, a type of skin cancer, often begins as melanoma in situ (MIS), which is considered a precursor to invasive melanoma. Traditionally, the management of MIS involves wide local excision to ensure complete removal. However, recent research has raised questions about the necessity of this approach for certain subtypes of MIS, particularly non-lentigo maligna (non-LM) and non-acral lentiginous (non-ALM) melanomas, where the risk of recurrence may be lower.
A retrospective cohort study conducted at the Skin Cancer and Melanoma Unit at Andreas Sygros University Hospital in Athens, Greece, shed light on the recurrence patterns and outcomes in patients with non-LM/non-ALM MIS. The study, which spanned over three decades from 1991 to 2023, included 401 patients with 403 lesions. Patients were followed up for a median of 5.2 years, with some individuals being monitored for up to 26 years. The majority of lesions were located on the trunk, with others appearing on the extremities or head and neck.
Initially, all patients underwent excisional biopsy, followed by wide excision in most cases. Surprisingly, the long-term follow-up revealed no instances of local recurrences, metastases, or melanoma-related deaths in cases where histopathological margins were clear. The sole recurrence occurred in a patient with involved margins who did not undergo further excision, eventually developing invasive melanoma.
Remarkably, patients with clear margins from excisional biopsy alone, who did not proceed to wide excision, showed no recurrence after a median follow-up of more than eight years. Similarly, those treated with wide excision using narrower margins than the standard also remained free of recurrence. A few suspicious lesions near excision sites were examined during follow-up, but histopathology indicated only benign changes such as solar lentigo or nevus.
These compelling findings suggest that in cases of non-LM/non-ALM MIS, excisional biopsy with clear margins may be sufficient as a treatment strategy, potentially sparing patients the associated morbidity of wider excisions. However, the researchers stress the need for larger studies before considering changes in clinical practice. Comparisons with current standard management protocols are also crucial to validate these findings.
The Study’s Key Findings
- Excisional biopsy with clear margins alone may be adequate in treating non-LM/non-ALM MIS.
- Patients with clear margins from excisional biopsy alone showed no recurrence after more than eight years.
- Wide excision using narrower margins than standard also led to no recurrences.
In conclusion, the study presents a promising alternative to the conventional approach of wide excision for certain subtypes of melanoma in situ. By highlighting the potential efficacy of excisional biopsy alone in cases with clear margins, the research opens up new avenues for personalized and minimally invasive treatment strategies in melanoma management. Further research and larger studies are warranted to validate these findings and potentially reshape the current standards of care in dermatological oncology.
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