Facial Location and Operating Room Environment are the Risk Factors for Incomplete Excision of Melanocytic Nevi
22. Februar 2018
13. August 2018
27. September 2018 (eFirst)
Introduction The management of melanocytic nevi involves many various practitioners with a high number of patients. Data on failure to achieve goals of treatment are scarce. We aimed to determine percentage of incompletely excised nevi and the risk factors responsible.
Materials and Methods In this retrospective cohort study, histology reports of all melanocytic nevi excised within our department between January 2014 and June 2015 were considered. Those aimed for stage excision and those with inconclusive histology reports were excluded. Patients' age, sex, anatomical location of the lesion, its size, as well as source of specimen (general surgical outpatients, surgical oncology outpatients, and operating room), and performing surgeon (trainee vs. consultant) were recorded. Chi-square test was used for statistical analysis with a p-value of < 0.05 considered significant.
Results A total of 739 nevi in 541 patients were analyzed. Positive margins were found in 80 (11%) of all specimens. There was significantly increased rate of incomplete excision of nevi from the facial area (42%; p < 0.001) versus other areas and, surprisingly, those excised in the operating room under general anesthesia (19%; p = 0.009). Nevi excised at our surgical oncology outpatients had the lowest rate (8%, p = 0.013) of incomplete excisions. There were no statistically significant differences in other variables.
Conclusion We identified facial location and operating room environment as risk factors for incomplete excision of melanocytic nevi. We suggest that human factors play a key role in achieving a good quality of service.
- 1 Tallon B, Snow J. Low clinically significant rate of recurrence in benign nevi. Am J Dermatopathol 2012; 34 (07) 706-709
- 2 Mendese G, Maloney M, Bordeaux J. To scoop or not to scoop: the diagnostic and therapeutic utility of the scoop-shave biopsy for pigmented lesions. Dermatol Surg 2014; 40 (10) 1077-1083
- 3 Chang TT, Somach SC, Wagamon K. , et al. The inadequacy of punch-excised melanocytic lesions: sampling through the block for the determination of “margins”. J Am Acad Dermatol 2009; 60 (06) 990-993
- 4 Kim CC, Swetter SM, Curiel-Lewandrowski C. , et al. Addressing the knowledge gap in clinical recommendations for management and complete excision of clinically atypical nevi/dysplastic nevi: Pigmented Lesion Subcommittee consensus statement. JAMA Dermatol 2015; 151 (02) 212-218
- 5 Murphy ME, Boyer JD, Stashower ME, Zitelli JA. The surgical management of Spitz nevi. Dermatol Surg 2002; 28 (11) 1065-1069
- 6 Malik V, Goh KS, Leong S, Tan A, Downey D, O'Donovan D. Risk and outcome analysis of 1832 consecutively excised basal cell carcinomas in a tertiary referral plastic surgery unit. J Plast Reconstr Aesthet Surg 2010; 63 (12) 2057-2063
- 7 Salmon P, Mortimer N, Rademaker M, Adams L, Stanway A, Hill S. Surgical excision of skin cancer: the importance of training. Br J Dermatol 2010; 162 (01) 117-122
- 8 Hansen C, Wilkinson D, Hansen M, Soyer HP. Factors contributing to incomplete excision of nonmelanoma skin cancer by Australian general practitioners. Arch Dermatol 2009; 145 (11) 1253-1260
- 9 Robinson AJ, Walsh M, Hill C. Histopathological variation of incompletely excised basal cell carcinoma's and the variation with the grade of surgeon - implications for revalidation. Eur J Surg Oncol 2015; 41 (01) 165-168