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Soo Park, MD
Soo Park, MD
Posted: Monday, September 22, 2025
According to Clio Dessinioti, MD, of Andreas Sygros Hospital, Athens, and colleagues, diagnostic excisional biopsy achieving clear margins may be sufficient for the treatment of melanoma in situ. Their findings from a retrospective cohort study were published in JAMA Dermatology.
“No local recurrences, metastasis, or melanoma-specific death were observed among patients with histologically clear margins treated with initial excisional biopsy alone or via wide excision,” the investigators added. “However, larger studies are necessary.”
The study included 401 patients with 403 non-lentigo maligna or non-acral lentiginous melanoma in situ lesions who were diagnosed between 1991 and 2023 and monitored for at least 1 year. The trunk was found to be the most frequent site of melanoma in situ (49.9%), followed by the lower extremities (24.6%), upper extremities (17.6%), and head and neck (7.9%). Initially, all lesions were managed with excisional biopsy, and 92.3% of patients underwent wide excision thereafter. The median duration of follow-up was 5.2 years.
The only local recurrence was observed in a patient with involved margins at excisional biopsy who did not undergo wide excision and subsequently developed invasive melanoma 14 months later. Among 30 patients with 30 lesions, all showed clear excisional biopsy margins without wide excision and no recurrence at a median follow-up of 8.1 years. At a median follow-up of 4.3 years, no recurrences were reported in 23 patients with 23 lesions treated by wide excision with margins narrower than the standard 0.5 cm (mean = 0.36 cm). During follow-up, six patients (1.5%) developed a lesion near the excision scar that appeared suspicious for recurrence; histopathology revealed nevus or solar lentigo. No metastatic events or melanoma-specific deaths were documented.
“Our findings should be confirmed with prospective, randomized trials and large multicenter retrospective studies that compare standard management with initial excisional biopsy with clear margins only,” the investigators concluded.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
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