If the nevus is benign, the plastic surgery strategy can be designed to completely remove it with the best possible aesthetic reconstruction. If the pathologist is experienced enough, identified margins can be checked by frozen section with the initial excision, avoiding further surgical intervention later if one or more of the margins prove to be involved. An accepted concept in cutaneous melanoma resection is 1 cm width of excision for every 1 mm in thickness. This may be appropriate for scalp, neck, trunk, and extremities, but not for lesions of the face nose, ears, eyelids, and forehead. This guidel ine may also be true for superficial spreading and nodular melanomas, but not for the desmoplastic variety, particularly those that exhibit neurotropism.
Desmoplastic melanomas have a propensity for repeated local recurrences.
Since most of these tumors are in the subcutaneous tissue, a i deep and wide excision is necessary for any hope of cure. Because the tumor itself can be confused with fibrous tissue, the accuracy of frozen section may be suspect in determining the validity of free surgical margin s at the time of excision. Fortunately, these lesions most often occur in areas where providing an acceptable cosmetic repair is less of a concern, i.e., scalp, temple, and neck. What constitutes an adequate workup for a patient with biopsy-proven melanoma of the head and neck is a timely question. Used with permission.