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Melanoma

E331: Are positive biopsy margins in melanoma significant? – A cohort study of micro- versus macroscopic margin status and their impact on residual disease and survival

    ePoster Abstract Author(s)

  • Alex Lee, MD

    Resident
    Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, The Ottawa Hospital
    Ottawa, Ontario, Canada

    • Submitter(s)

  • Alex Lee, MD

    Resident
    Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, The Ottawa Hospital
    Ottawa, Ontario, Canada

    • Author(s)

  • Alex Lee, MD

    Resident
    Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, The Ottawa Hospital
    Ottawa, Ontario, Canada

  • Boaz Wong, BMSc

    Researcher
    University of Ottawa
    Concord, Ontario, United States

  • HL

    Heidi Li, MD

    Resident
    Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, The Ottawa Hospital
    Ottawa, Ontario, Canada

  • EG

    Elysia Grose, MD

    Resident
    Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, The Ottawa Hospital, Ontario, Canada

  • OB

    Olivier Brandts-Longtin, BSc

    Medical student
    Faculty of Medicine, University of Ottawa
    Ottawa, Ontario, Canada

  • KA

    Katherine Aw, BMSc

    Medical student
    Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, The Ottawa Hospital
    Ottawa, Ontario, Canada

  • Rebecca Lau, BMSc (she/her/hers)

    Medical student
    Faculty of Medicine, University of Ottawa; Ottawa Hospital Research Institute, The Ottawa Hospital
    Ottawa, Ontario, Canada

  • AA

    Ahmad Abed, MD

    Resident
    Ottawa Hospital Research Institute, The Ottawa Hospital, United States

  • JS

    James Stevenson, MD

    Resident
    Ottawa Hospital Research Institute, The Ottawa Hospital, United States

  • RS

    Rahat Sheikh, BSc

    Medical student
    Ottawa Hospital Research Institute, The Ottawa Hospital, United States

  • RC

    Richard Chen, BSc

    Student
    Ottawa Hospital Research Institute, The Ottawa Hospital, Canada

  • CG

    Clara Goulet, n/a

    Student
    Ottawa Hospital Research Institute, The Ottawa Hospital, United States

  • SJ

    Stephanie Johnson-Obaseki, MD, MSc

    Physician
    Department of Head and Neck Surgery, University of Ottawa; Ottawa Hospital Research Institute, The Ottawa Hospital
    Ottawa, Ontario, Canada

  • Carolyn Nessim, MD, MSc

    Physician
    Division of General Surgery, Department of Surgery, University of Ottawa; Ottawa Hospital Research Institute, The Ottawa Hospital
    Ottawa, Ontario, Canada

Introduction: The 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. This study 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 855 patients, 44.7%, 31.9%, and 23.4% had negative, microscopically positive, and macroscopically positive margins, respectively. Incidence of residual invasive melanoma in the surgical specimen varied (P< 0.001), occurring in 9.4%, 15.0%, and 76.5% of patients, respectively. Predictors of residual disease included microscopically positive (P=0.026) and macroscopically positive biopsy margins (P< 0.001). Kaplan-Meier curves demonstrated comparable survival between those with negative and microscopically positive margins, but overall (P< 0.001) and recurrence-free survival (P< 0.001) were significantly worse in the macroscopically positive margin group. These patients had worse prognosis melanoma, 17.0% being >4mm in Breslow thickness, 33.0% being ulcerated, and 22.9% 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 and often have no further residual disease upon surgery. Patients with macroscopic residual melanoma must be prioritized for surgery due to their poorer prognosis.

Learning Objectives:

  • Upon completion, participants will be able to describe the differences in the presence of residual melanoma following a positive margin biopsy.
  • Upon completion, participants will be able to demonstrate evidence for comparable survival outcomes between those with negative biopsy margins and microscopically positive biopsy margins in melanoma.
  • Upon completion, participants will be able to better prioritize patients with positive margin biopsies in melanoma for surgical excision based on margin status (negative, microscopically positive, and macroscopically positive margins).