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Current Controversies in Melanoma Treatment | Jour ...
Journal CME Article: Current Controversies in Mela ...
Journal CME Article: Current Controversies in Melanoma Treatment V1
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Video Transcription
This presentation demonstrates the technique of staged perimeter excision for lenticulmaligna in critical anatomic locations. Another term for perimeter excision is SMEX, or staged margin-controlled excision. This patient has a lenticulmaligna of her left lateral canthal region with variable hyper and hypopigmentation. Here you can see the perimeter excision removing a fairly narrow strip of skin. A map is made, the true margin inked blue, and the pentagon shape used here will result in five strips of skin for the pathologist to examine on FAS. This shows the residual moat. Because the margins are submitted for permanent section, the pathologist will be able to review the margins, free from frozen section artifact, and will be able to use immunostains if desired. While awaiting pathology, the wound can be temporarily closed, leaving the central tumor intact on the cheek, which simplifies wound care. Any positive margin can then be revised in a similar fashion, submitting a parallel strip of skin in an area of positivity, and reclosing the moat. Once the margins are clear, the central tumor can be removed, and the reconstruction completed.
Video Summary
The presentation demonstrates staged perimeter excision (SMEX) for treating lentigo maligna in sensitive areas. The method involves removing narrow skin strips, inking the true margin, and creating a pentagon shape that results in five skin strips for analysis. Margins are examined on permanent sections, eliminating frozen section artifacts and allowing the use of immunostains. While awaiting results, the wound can be temporarily closed. If margins are positive, additional skin strips are removed and analyzed until clear. Once confirmed, the central tumor is excised and reconstruction is completed. This technique ensures thorough examination while simplifying wound care.
Keywords
staged perimeter excision
lentigo maligna
sensitive areas
immunostains
wound care
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