When we have patients sign consent forms for excisions, an overall complication risk is often cited as between 1 and 5%, but finding a source for this in the primary literature has been challenging. Is there a 'definitive' study on which this figure is based?
I agree a detailed analysis on the topic does not exist. Together with other colleagues had noticed that 5% of new diagnoses of melanoma lung metastases in general, were attributable to previous surgery for melanoma tumors unsafe. We had tried to do an editorial saying that maybe the surgery at all costs was not an option so rational. A metastatic tumor compared to one in situ is definitely a therapeutic problem. We should try to have biomarkers without performing surgery. I do not know if the answer can satisfy the colleague, but your question could be answered with another question: is it really necessary to perform radiotherapy after mastectomy? We create an inflammatory reaction as with surgery, this is a good environment for a tumor to develop.
Could not find either a special analysis or metastudy comprising all your "topics" mentioned so far.
The only 2 articles I could point you to are:
1. Excision margins in high-risk malignant melanoma.
Thomas JM, Newton-Bishop J, A'Hern R, Coombes G, Timmons M, Evans J, Cook M, Theaker J, Fallowfield M, O'Neill T, Ruka W, Bliss JM; United Kingdom Melanoma Study Group; British Association of Plastic Surgeons; Scottish Cancer Therapy Network.
N Engl J Med. 2004 Feb 19;350(8):757-66.
PMID: 14973217 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/14973217, Free Article @ NEJM cf. http://www.nejm.org/doi/full/10.1056/NEJMoa030681 , or http://www.nejm.org/doi/pdf/10.1056/NEJMoa030681;
and 2. http://www.ncbi.nlm.nih.gov/pubmed/23845614
J Pediatr Surg. 2013 Jun;48(6):1249-53. doi: 10.1016/j.jpedsurg.2013.03.018.
Complications in the surgical treatment of pediatric melanoma.
Palmer PE 3rd1, Warneke CL, Hayes-Jordan AA, Herzog CE, Hughes DP, Lally KP, Austin MT.
You can look at these reports:
Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1 to 4 mm). Results of a multi-institutional randomized surgical trial. Balch et al 1993 at page 265.
And a newer reference:
A prospective evaluation of the incidence of complications associated with Mohs micrographic surgery. Cook 2003
Best regards
The complication rate would not be associated with the melanocytic lesion as such, but more to do with the quality of surrounding skin, the type of wound closure (direct, graft, flap etc) and whether there was any excess tension, co-morbidities or smoking. Also, the duration of disease is a factor. It's one thing to excise a primary melanoma on a leg that is "virgin territory", but quite another to excise a fifth local recurrence from a limb that is now scarred and lymphoedematous. Too many authors of wound closure and complications articles lump all their ops together, rather than stratifying them according to co-morbidities. Also, you have to think about what is really a complication. When a colleague excised a lesion from scalp and applied a purse string suture, leaving most open to heal "secondarily", I considered this a complication when it was not healed three months later! Beware of studies that blandly state "Good outcomes were achieved."
The same as for any non melanocytic neoplasm. If done with proper surgical techniques
the incidence of infection should be low.
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