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Master Thesis

La chirurgie des mélanomes de Dubreuilh de la face et du cou : à propos d’une étude sur une série rétrospective de 204 cas

Abstract : Introduction: lentigo maligna (LM) and lentigo maligna melanoma (LMM) are pigmented tumors that occurs on the sun exposed skin, particulary the head and neck of ederly patients. Surgery is the recommended first line treatment for these lesions. However large defects, surgical margins, and reconstructive procedures are challenging. The aim of this study was to examine the impact of surgical excision without appropriate margin of clearance (<5mm). We also evaluated reconstructive surgical options and predictive factors of recurrence. Methods: this retrospective study included patients with head and neack LM/LMM, operated at Nice and Toulouse cancer center hospitals, from 2004 to 2019. Results: two hundred four patients with mean age of 72.5 years were included. Tumors with mean size of 18 mm were preferentially localized on cheek (55%) and nose (22%). Eighty-four patients had primary surgical excision with no enough safety margins. Tumour larger than 20mm was significantly associated with risk of insufficient margin of clearance (p = 0.02). Skin simple suture was the reconstruction option without postoperative complication (p<0.05). Periorbital location and size superior to 20 mm were associated with an increased risk of recurrence (p<0.05). Discussion: infraclinical extension of LM/LMM and facial localization of the tumor are factors wich make complete resection difficult. Tumor larger than 20mm should be excised with 10 mm margin of clearance with strict follow up as these tumours have a high potential for local recurrence. Skin simple suture option, when possible with small-sized tumors, reduces the risk of postoperative complications. Skin grafts or flaps didn’t show any significant difference in terms of complications. Recurrences should be monitored more often by the dermatologist, especially when the initial tumour is extensive and peri-orbital. Conclusion: a tumour larger than 20mm is a risk factor for incomplete tumour resection, and periorificial localization increases the rate of recurrence. The result of the preoperative biopsy may differ from the final histology, but is of primary importance in the initial evaluation of the disease.
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Master Thesis
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Contributor : Bibliothèque Universitaire de Médecine Nice Connect in order to contact the contributor
Submitted on : Friday, September 3, 2021 - 2:24:40 PM
Last modification on : Tuesday, December 7, 2021 - 4:10:58 PM
Long-term archiving on: : Saturday, December 4, 2021 - 7:19:32 PM


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  • HAL Id : dumas-03334076, version 1


Agathe Villarmé. La chirurgie des mélanomes de Dubreuilh de la face et du cou : à propos d’une étude sur une série rétrospective de 204 cas. Médecine humaine et pathologie. 2020. ⟨dumas-03334076⟩



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