Excision Margins

Distances (mm) to the nearest painted deep and peripheral excision margins either of quadrant blocks if specimen size allows or serial slices

(toast racked)—of the vertical and radial disease phases and any in-situ change.

Minimum recommended margins of clearance vary according to the tumour depth of invasion:

Depth Minimum margin

0.76-2mm 10 mm

Adequate treatment is based on successful complete primary excision or, if there is initial margin involvement, secondary re-excision. This is supplemented by regional node dissection and systemic therapy for metastatic disease. Sentinel lymph node biopsy may be used in patients with clinically negative regional lymph nodes and a vertical growth phase malignant melanoma > 1 mm thick. It involves serially slicing the node with preparation of multiple haematoxylin and eosin (H&E) and matching immunohistochemical stains for S100 and HMB-45. Differential diagnoses include sinus histiocytes, capsular naevus cell nests and benign ductal epithelial inclusions. If positive, a regional lymphadenectomy is carried out.

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