The rule of 10s versus the rule of 2s: High complication rates after conventional excision with postoperative margin assessment of specialty site versus trunk and proximal extremity melanomas
| Autor: | Jeremy R. Etzkorn, Nicole Howe, Christopher J. Miller, Alexandra K. Rzepecki, Joseph F. Sobanko, Thuzar M. Shin, Charles Hwang |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Skin Neoplasms Dermatologic Surgical Procedures Specialty Dermatology 030207 dermatology & venereal diseases 03 medical and health sciences Postoperative Complications 0302 clinical medicine Margin (machine learning) Humans Medicine Head and neck Melanoma Frozen section procedure business.industry Margins of Excision Torso Extremities Mohs Surgery medicine.disease Trunk Surgery 030220 oncology & carcinogenesis Practice Guidelines as Topic Tumor removal business Complication |
| Zdroj: | Journal of the American Academy of Dermatology. 85:442-452 |
| ISSN: | 0190-9622 |
| DOI: | 10.1016/j.jaad.2018.11.008 |
| Popis: | Specialty site melanomas on the head and neck, hands and feet, genitalia, and pretibial leg have higher rates of surgical complications after conventional excision with postoperative margin assessment (CE-POMA) compared with trunk and proximal extremity melanomas. The rule of 10s describes complication rates after CE-POMA of specialty site melanomas: ∼10% risk for upstaging, ∼10% risk for positive excision margins, ∼10% risk for local recurrence, and ∼10-fold increased likelihood of reconstruction with a flap or graft. Trunk and proximal extremity melanomas encounter these complications at a lower rate, according to the rule of 2s. Mohs micrographic surgery (MMS) with frozen section melanocytic immunostains (MMS-I) and slow Mohs with paraffin sections decrease complications of surgery of specialty site melanomas by detecting upstaging and confirming complete tumor removal with comprehensive microscopic margin assessment before reconstruction. This article reviews information important for counseling melanoma patients about surgical treatment options and for developing consensus guidelines with clear indications for MMS-I or slow Mohs. |
| Databáze: | OpenAIRE |
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