Systematic review and meta-analysis of local recurrence rates of head and neck cutaneous melanomas after wide local excision, Mohs micrographic surgery, or staged excision

JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

卷:85

Review

Bittar, Peter G.¹  Bittar, Julie M.²  Etzkorn, Jeremy R.³  Brewer, Jerry D.⁴  Aizman, Leora⁵  Shin, Thuzar M.³  Sobanko, Joseph F.³  Higgins, Harold W.³  Giordano, Cerrene N.³  Cohen, Justine V.⁶  Pride, Renee⁴  Wan, Marilyn T.³  Leitenberger, Justin J.⁷  Bar, Anna A.⁷  Aasi, Sumaira⁸  Bordeaux, Jeremy S.⁹  Miller, Christopher J.³ 

[1] Indiana Univ Sch Med, Dept Dermatol, Indianapolis, IN 46202 USA

[2] Rush Univ, Med Ctr, Dermatol Sect, Chicago, IL 60612 USA

[3] Hosp Univ Penn, Dept Dermatol, 3400 Civ Ctr Blvd,Suite 1-330S, Philadelphia, PA 19104 USA

[4] Mayo Clin, Dept Dermatol, Rochester, MN USA

[5] George Washington Univ, Sch Med, Washington, DC USA

[6] Hosp Univ Penn, Dept Med, Div Hematol & Oncol, Philadelphia, PA 19104 USA

[7] Oregon Hlth & Sci Univ, Dept Dermatol, Portland, OR 97201 USA

[8] Stanford Med, Dept Dermatol, Stanford, CA USA

[9] Univ Hosp, Dept Dermatol, Cleveland, OH USA

关键词: clinical research;    dermatologic surgery;    evidence-based medicine;    excision;    general dermatology;    head and neck;    lentigo maligna;    local recurrence;    melanoma;    Mohs micrographic surgery;    oncology;    outcomes;    staged excision;    systematic review;    wide local excision;   

DOI  :  10.1016/j.jaad.2021.04.090

来源: Elsevier

【 摘 要 】

Background: Prospective trials have not compared the local recurrence rates of different excision techniques for cutaneous melanomas on the head and neck. Objective: To determine local recurrence rates of cutaneous head and neck melanoma after wide local excision (WLE), Mohs micrographic surgery (MMS), or staged excision. Methods: A systematic review of PubMed, EMBASE, and Web of Science identified all English case series, cohort studies, and randomized controlled trials that reported local recurrence rates after surgery for cutaneous head and neck melanoma. A meta-analysis utilizing a random effects model calculated weighted local recurrence rates and confidence intervals (CI) for each surgical technique and for subgroups of MMS and staged excision. Results: Among 100 manuscripts with 13,998 head and neck cutaneous melanomas, 51.0% (7138) of melanomas were treated by WLE, 34.5% (4826) by MMS, and 14.5% (2034) by staged excision. Local recurrence rates were lowest for MMS (0.61%; 95% CI, 0.1%-1.4%), followed by staged excision (1.8%; 95% CI, 1.0%-2.9%) and WLE (7.8%; 95% CI, 6.4%-9.3%). Limitations: Definitions of local recurrence varied. Surgical techniques included varying proportions of invasive melanomas. Studies had heterogeneity. Conclusion: Systematic review and meta-analysis show lower local recurrence rates for cutaneous head and neck melanoma after treatment with MMS or staged excision compared to WLE.

【 授权许可】

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