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Are Positive Biopsy Margins in Melanoma Significant?: A Cohort Study of Micro- Versus Macroscopic Margin Status and Their Impact on Residual Disease and Survival
Background Presence of positive biopsy margins in melanoma can provoke anxiety over potential disease progression from delays to surgical excision, but their impact on outcomes is unknown. We aimed to compare the presence of residual melanoma in the surgical excision specimen and survival between pa...
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| Published in: | Annals of surgical oncology 2025, Vol.32 (1), p.474-481 |
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| container_end_page | 481 |
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| container_title | Annals of surgical oncology |
| container_volume | 32 |
| creator | Lee, Alex Wong, Boaz Li, Heidi Grose, Elysia Brandts-Longtin, Olivier Aw, Katherine Lau, Rebecca Abed, Ahmad Stevenson, James Sheikh, Rahat Chen, Richard Goulet, Clara Johnson-Obaseki, Stephanie Nessim, Carolyn |
| description | Background
Presence of positive biopsy margins in melanoma can provoke anxiety over potential disease progression from delays to surgical excision, but their impact on outcomes is unknown. We aimed to compare the presence of residual melanoma in the surgical excision specimen and survival between patients with negative, microscopically positive, and macroscopically positive biopsy margins.
Methods
Patients with cutaneous melanoma who underwent surgical excision over a 13-year period were included. Biopsy characteristics, residual disease in the surgical specimen, and overall and recurrence-free survival were compared between patients with negative, microscopically positive (only scar visible), and macroscopically positive (visible remaining melanoma) biopsy margins.
Results
Of 901 patients, 42.4%, 33.3%, and 24.3% had negative, microscopically positive, and macroscopically positive margins, respectively. The incidence of residual invasive melanoma in the surgical specimen varied (
P
|
| doi_str_mv | 10.1245/s10434-024-16301-w |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3114503121</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3147279178</sourcerecordid><originalsourceid>FETCH-LOGICAL-c256t-2bd0e2e0f905fedaf1c3c98d1faf1c3c0b17bc33a675614a19b980642e440ffc3</originalsourceid><addsrcrecordid>eNp9kU1v1DAQhi0EoqXwBzggS1y4BDy288UFLctXpa5AbOEaOc546yqxg51stT-Hf4rbLCBx4OSx55l3PPMS8hTYS-AyfxWBSSEzxmUGhWCQ3dwjp5CnJ1lUcD_FrKiymhf5CXkU4zVjUAqWPyQnohYVL2V5Sn6uAtIvPtrJ7pG-tX6MB7pRYWddpNbRDfbK-UHRrd05a6xWbnrzmq7o2l_5MNHtNHcH6g3dWB18Rr9jiHNMCukWtR-tPqolUk0po1xHL6_QBno-jEpP1Dv6FaPtZtXTdzaiingHbeewt3vVPyYPjOojPjmeZ-Tbh_eX60_ZxeeP5-vVRaZ5XkwZbzuGHJmpWW6wUwa00HXVgVlC1kLZaiFUUeYFSAV1W1eskBylZMZocUZeLLpj8D9mjFMz2KixT_Ojn2MjAGTOBHBI6PN_0Gs_B5d-lyhZ8rKGskoUX6jbVcSAphmDHVQ4NMCaWwObxcAmGdjcGdjcpKJnR-m5HbD7U_LbsQSIBYgp5XYY_vb-j-wvjdun7w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3147279178</pqid></control><display><type>article</type><title>Are Positive Biopsy Margins in Melanoma Significant?: A Cohort Study of Micro- Versus Macroscopic Margin Status and Their Impact on Residual Disease and Survival</title><source>Springer Nature</source><creator>Lee, Alex ; Wong, Boaz ; Li, Heidi ; Grose, Elysia ; Brandts-Longtin, Olivier ; Aw, Katherine ; Lau, Rebecca ; Abed, Ahmad ; Stevenson, James ; Sheikh, Rahat ; Chen, Richard ; Goulet, Clara ; Johnson-Obaseki, Stephanie ; Nessim, Carolyn</creator><creatorcontrib>Lee, Alex ; Wong, Boaz ; Li, Heidi ; Grose, Elysia ; Brandts-Longtin, Olivier ; Aw, Katherine ; Lau, Rebecca ; Abed, Ahmad ; Stevenson, James ; Sheikh, Rahat ; Chen, Richard ; Goulet, Clara ; Johnson-Obaseki, Stephanie ; Nessim, Carolyn</creatorcontrib><description>Background
Presence of positive biopsy margins in melanoma can provoke anxiety over potential disease progression from delays to surgical excision, but their impact on outcomes is unknown. We aimed to compare the presence of residual melanoma in the surgical excision specimen and survival between patients with negative, microscopically positive, and macroscopically positive biopsy margins.
Methods
Patients with cutaneous melanoma who underwent surgical excision over a 13-year period were included. Biopsy characteristics, residual disease in the surgical specimen, and overall and recurrence-free survival were compared between patients with negative, microscopically positive (only scar visible), and macroscopically positive (visible remaining melanoma) biopsy margins.
Results
Of 901 patients, 42.4%, 33.3%, and 24.3% had negative, microscopically positive, and macroscopically positive margins, respectively. The incidence of residual invasive melanoma in the surgical specimen varied (
P
< 0.001), occurring in 5.5%, 17.0%, and 74.9% of patients, respectively. Both microscopically and macroscopically positive margins were associated with residual disease (
P
< 0.001) but only the latter predicted worse overall (
P
= 0.013) and recurrence-free survival (
P
= 0.009). Kaplan–Meier estimated survival was comparable between those with negative and microscopically positive margins, but overall (
P
= 0.006) and recurrence-free survival (
P
= 0.004) were significantly worse in the macroscopically positive margin group. These patients had worse prognosis melanoma, with 33.8% being stage III disease, and 23.2% having positive sentinel lymph nodes.
Conclusions
Patients and physicians may be reassured in the presence of microscopically positive biopsy margins which are not associated with worse survival, However, patients with macroscopically positive margins have poorer prognosis and should be treated within an acceptable time frame.</description><identifier>ISSN: 1068-9265</identifier><identifier>ISSN: 1534-4681</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-024-16301-w</identifier><identifier>PMID: 39382747</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biopsy ; Female ; Follow-Up Studies ; Humans ; Lymph nodes ; Male ; Margins of Excision ; Medical prognosis ; Medicine ; Medicine & Public Health ; Melanoma ; Melanoma - mortality ; Melanoma - pathology ; Melanoma - surgery ; Melanoma and Cutaneous Oncology ; Middle Aged ; Neoplasm Recurrence, Local - pathology ; Neoplasm Recurrence, Local - surgery ; Neoplasm, Residual - pathology ; Oncology ; Prognosis ; Retrospective Studies ; Sentinel Lymph Node Biopsy ; Skin Neoplasms - mortality ; Skin Neoplasms - pathology ; Skin Neoplasms - surgery ; Surgery ; Surgical Oncology ; Survival ; Survival Rate ; Young Adult</subject><ispartof>Annals of surgical oncology, 2025, Vol.32 (1), p.474-481</ispartof><rights>Society of Surgical Oncology 2024 Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. Society of Surgical Oncology.</rights><rights>Copyright Springer Nature B.V. Jan 2025</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c256t-2bd0e2e0f905fedaf1c3c98d1faf1c3c0b17bc33a675614a19b980642e440ffc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39382747$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Alex</creatorcontrib><creatorcontrib>Wong, Boaz</creatorcontrib><creatorcontrib>Li, Heidi</creatorcontrib><creatorcontrib>Grose, Elysia</creatorcontrib><creatorcontrib>Brandts-Longtin, Olivier</creatorcontrib><creatorcontrib>Aw, Katherine</creatorcontrib><creatorcontrib>Lau, Rebecca</creatorcontrib><creatorcontrib>Abed, Ahmad</creatorcontrib><creatorcontrib>Stevenson, James</creatorcontrib><creatorcontrib>Sheikh, Rahat</creatorcontrib><creatorcontrib>Chen, Richard</creatorcontrib><creatorcontrib>Goulet, Clara</creatorcontrib><creatorcontrib>Johnson-Obaseki, Stephanie</creatorcontrib><creatorcontrib>Nessim, Carolyn</creatorcontrib><title>Are Positive Biopsy Margins in Melanoma Significant?: A Cohort Study of Micro- Versus Macroscopic Margin Status and Their Impact on Residual Disease and Survival</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
Presence of positive biopsy margins in melanoma can provoke anxiety over potential disease progression from delays to surgical excision, but their impact on outcomes is unknown. We aimed to compare the presence of residual melanoma in the surgical excision specimen and survival between patients with negative, microscopically positive, and macroscopically positive biopsy margins.
Methods
Patients with cutaneous melanoma who underwent surgical excision over a 13-year period were included. Biopsy characteristics, residual disease in the surgical specimen, and overall and recurrence-free survival were compared between patients with negative, microscopically positive (only scar visible), and macroscopically positive (visible remaining melanoma) biopsy margins.
Results
Of 901 patients, 42.4%, 33.3%, and 24.3% had negative, microscopically positive, and macroscopically positive margins, respectively. The incidence of residual invasive melanoma in the surgical specimen varied (
P
< 0.001), occurring in 5.5%, 17.0%, and 74.9% of patients, respectively. Both microscopically and macroscopically positive margins were associated with residual disease (
P
< 0.001) but only the latter predicted worse overall (
P
= 0.013) and recurrence-free survival (
P
= 0.009). Kaplan–Meier estimated survival was comparable between those with negative and microscopically positive margins, but overall (
P
= 0.006) and recurrence-free survival (
P
= 0.004) were significantly worse in the macroscopically positive margin group. These patients had worse prognosis melanoma, with 33.8% being stage III disease, and 23.2% having positive sentinel lymph nodes.
Conclusions
Patients and physicians may be reassured in the presence of microscopically positive biopsy margins which are not associated with worse survival, However, patients with macroscopically positive margins have poorer prognosis and should be treated within an acceptable time frame.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biopsy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Lymph nodes</subject><subject>Male</subject><subject>Margins of Excision</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Melanoma</subject><subject>Melanoma - mortality</subject><subject>Melanoma - pathology</subject><subject>Melanoma - surgery</subject><subject>Melanoma and Cutaneous Oncology</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neoplasm Recurrence, Local - surgery</subject><subject>Neoplasm, Residual - pathology</subject><subject>Oncology</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Sentinel Lymph Node Biopsy</subject><subject>Skin Neoplasms - mortality</subject><subject>Skin Neoplasms - pathology</subject><subject>Skin Neoplasms - surgery</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival</subject><subject>Survival Rate</subject><subject>Young Adult</subject><issn>1068-9265</issn><issn>1534-4681</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><recordid>eNp9kU1v1DAQhi0EoqXwBzggS1y4BDy288UFLctXpa5AbOEaOc546yqxg51stT-Hf4rbLCBx4OSx55l3PPMS8hTYS-AyfxWBSSEzxmUGhWCQ3dwjp5CnJ1lUcD_FrKiymhf5CXkU4zVjUAqWPyQnohYVL2V5Sn6uAtIvPtrJ7pG-tX6MB7pRYWddpNbRDfbK-UHRrd05a6xWbnrzmq7o2l_5MNHtNHcH6g3dWB18Rr9jiHNMCukWtR-tPqolUk0po1xHL6_QBno-jEpP1Dv6FaPtZtXTdzaiingHbeewt3vVPyYPjOojPjmeZ-Tbh_eX60_ZxeeP5-vVRaZ5XkwZbzuGHJmpWW6wUwa00HXVgVlC1kLZaiFUUeYFSAV1W1eskBylZMZocUZeLLpj8D9mjFMz2KixT_Ojn2MjAGTOBHBI6PN_0Gs_B5d-lyhZ8rKGskoUX6jbVcSAphmDHVQ4NMCaWwObxcAmGdjcGdjcpKJnR-m5HbD7U_LbsQSIBYgp5XYY_vb-j-wvjdun7w</recordid><startdate>2025</startdate><enddate>2025</enddate><creator>Lee, Alex</creator><creator>Wong, Boaz</creator><creator>Li, Heidi</creator><creator>Grose, Elysia</creator><creator>Brandts-Longtin, Olivier</creator><creator>Aw, Katherine</creator><creator>Lau, Rebecca</creator><creator>Abed, Ahmad</creator><creator>Stevenson, James</creator><creator>Sheikh, Rahat</creator><creator>Chen, Richard</creator><creator>Goulet, Clara</creator><creator>Johnson-Obaseki, Stephanie</creator><creator>Nessim, Carolyn</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TO</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>2025</creationdate><title>Are Positive Biopsy Margins in Melanoma Significant?: A Cohort Study of Micro- Versus Macroscopic Margin Status and Their Impact on Residual Disease and Survival</title><author>Lee, Alex ; Wong, Boaz ; Li, Heidi ; Grose, Elysia ; Brandts-Longtin, Olivier ; Aw, Katherine ; Lau, Rebecca ; Abed, Ahmad ; Stevenson, James ; Sheikh, Rahat ; Chen, Richard ; Goulet, Clara ; Johnson-Obaseki, Stephanie ; Nessim, Carolyn</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c256t-2bd0e2e0f905fedaf1c3c98d1faf1c3c0b17bc33a675614a19b980642e440ffc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biopsy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Lymph nodes</topic><topic>Male</topic><topic>Margins of Excision</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Melanoma</topic><topic>Melanoma - mortality</topic><topic>Melanoma - pathology</topic><topic>Melanoma - surgery</topic><topic>Melanoma and Cutaneous Oncology</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Neoplasm Recurrence, Local - surgery</topic><topic>Neoplasm, Residual - pathology</topic><topic>Oncology</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Sentinel Lymph Node Biopsy</topic><topic>Skin Neoplasms - mortality</topic><topic>Skin Neoplasms - pathology</topic><topic>Skin Neoplasms - surgery</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Survival</topic><topic>Survival Rate</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Alex</creatorcontrib><creatorcontrib>Wong, Boaz</creatorcontrib><creatorcontrib>Li, Heidi</creatorcontrib><creatorcontrib>Grose, Elysia</creatorcontrib><creatorcontrib>Brandts-Longtin, Olivier</creatorcontrib><creatorcontrib>Aw, Katherine</creatorcontrib><creatorcontrib>Lau, Rebecca</creatorcontrib><creatorcontrib>Abed, Ahmad</creatorcontrib><creatorcontrib>Stevenson, James</creatorcontrib><creatorcontrib>Sheikh, Rahat</creatorcontrib><creatorcontrib>Chen, Richard</creatorcontrib><creatorcontrib>Goulet, Clara</creatorcontrib><creatorcontrib>Johnson-Obaseki, Stephanie</creatorcontrib><creatorcontrib>Nessim, Carolyn</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Alex</au><au>Wong, Boaz</au><au>Li, Heidi</au><au>Grose, Elysia</au><au>Brandts-Longtin, Olivier</au><au>Aw, Katherine</au><au>Lau, Rebecca</au><au>Abed, Ahmad</au><au>Stevenson, James</au><au>Sheikh, Rahat</au><au>Chen, Richard</au><au>Goulet, Clara</au><au>Johnson-Obaseki, Stephanie</au><au>Nessim, Carolyn</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Are Positive Biopsy Margins in Melanoma Significant?: A Cohort Study of Micro- Versus Macroscopic Margin Status and Their Impact on Residual Disease and Survival</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2025</date><risdate>2025</risdate><volume>32</volume><issue>1</issue><spage>474</spage><epage>481</epage><pages>474-481</pages><issn>1068-9265</issn><issn>1534-4681</issn><eissn>1534-4681</eissn><abstract>Background
Presence of positive biopsy margins in melanoma can provoke anxiety over potential disease progression from delays to surgical excision, but their impact on outcomes is unknown. We aimed to compare the presence of residual melanoma in the surgical excision specimen and survival between patients with negative, microscopically positive, and macroscopically positive biopsy margins.
Methods
Patients with cutaneous melanoma who underwent surgical excision over a 13-year period were included. Biopsy characteristics, residual disease in the surgical specimen, and overall and recurrence-free survival were compared between patients with negative, microscopically positive (only scar visible), and macroscopically positive (visible remaining melanoma) biopsy margins.
Results
Of 901 patients, 42.4%, 33.3%, and 24.3% had negative, microscopically positive, and macroscopically positive margins, respectively. The incidence of residual invasive melanoma in the surgical specimen varied (
P
< 0.001), occurring in 5.5%, 17.0%, and 74.9% of patients, respectively. Both microscopically and macroscopically positive margins were associated with residual disease (
P
< 0.001) but only the latter predicted worse overall (
P
= 0.013) and recurrence-free survival (
P
= 0.009). Kaplan–Meier estimated survival was comparable between those with negative and microscopically positive margins, but overall (
P
= 0.006) and recurrence-free survival (
P
= 0.004) were significantly worse in the macroscopically positive margin group. These patients had worse prognosis melanoma, with 33.8% being stage III disease, and 23.2% having positive sentinel lymph nodes.
Conclusions
Patients and physicians may be reassured in the presence of microscopically positive biopsy margins which are not associated with worse survival, However, patients with macroscopically positive margins have poorer prognosis and should be treated within an acceptable time frame.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>39382747</pmid><doi>10.1245/s10434-024-16301-w</doi><tpages>8</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Biopsy Female Follow-Up Studies Humans Lymph nodes Male Margins of Excision Medical prognosis Medicine Medicine & Public Health Melanoma Melanoma - mortality Melanoma - pathology Melanoma - surgery Melanoma and Cutaneous Oncology Middle Aged Neoplasm Recurrence, Local - pathology Neoplasm Recurrence, Local - surgery Neoplasm, Residual - pathology Oncology Prognosis Retrospective Studies Sentinel Lymph Node Biopsy Skin Neoplasms - mortality Skin Neoplasms - pathology Skin Neoplasms - surgery Surgery Surgical Oncology Survival Survival Rate Young Adult |
| title | Are Positive Biopsy Margins in Melanoma Significant?: A Cohort Study of Micro- Versus Macroscopic Margin Status and Their Impact on Residual Disease and Survival |
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