{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T08:01:35Z","timestamp":1779350495717,"version":"3.51.4"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"Importance<\/jats:title>The incidence of melanoma in situ (MIS) has increased significantly over the past decades, and traditional guidelines for treatment of MIS have been excision with a 5-mm clinical margin; however, current Australian and other guidelines now recommend 5- to 10-mm margins. This changed recommendation was largely driven by the outcomes of studies using Mohs micrographic surgery, and recent studies using Mohs micrographic surgery are advocating for even wider excisions up to 18 mm for clearance.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess the rate of recurrence of MIS excised with a 5-mm margin.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This case series studied all MIS lesions from a single private dermatology clinic between January 1, 2011, and November 30, 2018. The criteria for inclusion were a documented 5-mm excisional margin on operation report and more than 5 years of site-specific follow-up after wide local excision. Lesions were excluded if the excisional margin was more than 5 mm or undocumented, there was less than 5 years of follow-up, or they required more than 1 wide local excision. Data analysis was performed January 30 to February 25, 2024.<\/jats:p><\/jats:sec>Intervention<\/jats:title>Wide local excision with 5-mm margin.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 351 MISs were identified from 292 patients (mean [SD] age, 60.3 [11.8] years; 162 females [55.5%]). Superficial spreading melanoma was the most common subtype diagnosed (177 lesions [50.4%]), followed by lentigo maligna (107 lesions [30.5%]) and lentiginous MIS (67 lesions [19.1%]). The trunk was the most common location of lesions (168 lesions [47.9%]), followed by upper limb (96 lesions [27.4%]) and lower limb (59 lesions [16.8%]). Scalp was the least common location (2 lesions [0.6%]). Most of the lesions were small, with 274 lesions (78.1%) having a length less than 10 mm and 312 lesions (88.9%) having a width less than 10 mm. A total of 348 lesions (99.1%) did not have clinical recurrence after excision with a 5-mm clinical margin following then current guidelines. A total of 3 lesions (0.9%) experienced local recurrence with no metastatic spread.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This case series found that excision with a 5-mm margin for MIS of smaller size (&amp;lt;10 mm) on low-risk body sites had a low rate of recurrence. Conservative 5-mm excisional margin is likely to be suitable for small MIS on lower-risk body sites.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamadermatol.2024.1878","type":"journal-article","created":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T15:38:31Z","timestamp":1719416311000},"page":"874","source":"Crossref","is-referenced-by-count":9,"title":["Recurrence Rate of Small Melanoma In Situ on Low-Risk Sites Excised With 5-mm Excisional Margin"],"prefix":"10.1001","volume":"160","author":[{"given":"Cong","family":"Sun","sequence":"first","affiliation":[{"name":"Mater Hospital Brisbane Raymond Terrace, South Brisbane, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alvin","family":"Lim","sequence":"additional","affiliation":[{"name":"South East Dermatology Unit 9, Annerley, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"De\u2019Ambrosis","sequence":"additional","affiliation":[{"name":"South East Dermatology Unit 9, Annerley, Queensland, Australia"},{"name":"School of Medicine, University of Queensland, St Lucia, Brisbane, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Yong-Gee","sequence":"additional","affiliation":[{"name":"South East Dermatology Unit 9, Annerley, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louis","family":"Pool","sequence":"additional","affiliation":[{"name":"Sullivan Nicolaides Pathology, Bowen Hills, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Muir","sequence":"additional","affiliation":[{"name":"Mater Hospital Brisbane Raymond Terrace, South Brisbane, Queensland, Australia"},{"name":"South East Dermatology Unit 9, Annerley, Queensland, Australia"},{"name":"School of Medicine, University of Queensland, St Lucia, Brisbane, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","reference":[{"issue":"10","key":"dbr240011r1","doi-asserted-by":"publisher","first-page":"1364","DOI":"10.1093\/jnci\/djac138","article-title":"Incidence of in situ vs invasive melanoma: testing the \u201cobligate precursor\u201d hypothesis.","volume":"114","author":"Olsen","year":"2022","journal-title":"J Natl Cancer Inst"},{"issue":"10","key":"dbr240011r2","doi-asserted-by":"publisher","first-page":"1314","DOI":"10.1001\/jama.1992.03490100112037","article-title":"Diagnosis and treatment of early melanoma: NIH Consensus Development Panel on Early Melanoma.","volume":"268","author":"Goldsmith","year":"1992","journal-title":"JAMA"},{"issue":"7","key":"dbr240011r4","doi-asserted-by":"publisher","first-page":"3506","DOI":"10.1007\/s12325-021-01783-x","article-title":"Melanoma in situ: a critical review and re-evaluation of current excision margin recommendations.","volume":"38","author":"Friedman","year":"2021","journal-title":"Adv Ther"},{"issue":"4","key":"dbr240011r5","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1016\/j.jaad.2014.12.016","article-title":"Surgical margins for melanoma in situ: when 5-mm margins are really 9 mm.","volume":"72","author":"Kunishige","year":"2015","journal-title":"J Am Acad Dermatol"},{"issue":"1","key":"dbr240011r6","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1016\/j.jaad.2019.01.051","article-title":"Comparison of surgical margins for lentigo maligna versus melanoma in situ.","volume":"81","author":"Kunishige","year":"2019","journal-title":"J Am Acad Dermatol"},{"key":"dbr240011r7","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.jdin.2022.01.008","article-title":"Lentigo Maligna of the head and neck: a retrospective study assessing surgical excision margins in a South African population.","volume":"7","author":"de Wet","year":"2022","journal-title":"JAAD Int"},{"issue":"6","key":"dbr240011r8","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1634\/theoncologist.2010-0340","article-title":"Cutaneous melanoma in situ: translational evidence from a large population-based study.","volume":"16","author":"Mocellin","year":"2011","journal-title":"Oncologist"},{"issue":"7","key":"dbr240011r9","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1001\/jamadermatol.2023.1494","article-title":"Risk of mortality after a diagnosis of melanoma in situ.","volume":"159","author":"Patel","year":"2023","journal-title":"JAMA Dermatol"},{"issue":"5","key":"dbr240011r10","doi-asserted-by":"publisher","first-page":"e163","DOI":"10.1016\/j.jaad.2019.12.069","article-title":"Five-millimeter lateral margins are appropriate in the treatment of melanoma in situ.","volume":"82","author":"Valencia","year":"2020","journal-title":"J Am Acad Dermatol"},{"issue":"5","key":"dbr240011r11","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1001\/jamadermatol.2016.6138","article-title":"Outcomes of melanoma in situ treated with Mohs micrographic surgery compared with wide local excision.","volume":"153","author":"Nosrati","year":"2017","journal-title":"JAMA Dermatol"},{"issue":"1","key":"dbr240011r12","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.jaad.2004.08.038","article-title":"Cutaneous head and neck melanoma treated with Mohs micrographic surgery.","volume":"52","author":"Bricca","year":"2005","journal-title":"J Am Acad Dermatol"},{"issue":"8","key":"dbr240011r13","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1046\/j.1524-4725.2000.00081.x","article-title":"Mohs micrographic excision of melanoma using immunostains.","volume":"26","author":"Zalla","year":"2000","journal-title":"Dermatol Surg"},{"issue":"5","key":"dbr240011r14","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1067\/mjd.2002.124085","article-title":"Histologic evaluation of lentigo maligna with permanent sections: implications regarding current guidelines.","volume":"47","author":"Agarwal-Antal","year":"2002","journal-title":"J Am Acad Dermatol"},{"issue":"9","key":"dbr240011r15","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1001\/archderm.140.9.1087","article-title":"Surgical margins for lentigo maligna and lentigo maligna melanoma: the technique of mapped serial excision.","volume":"140","author":"Huilgol","year":"2004","journal-title":"Arch Dermatol"},{"key":"dbr240011r3","unstructured":"Sladden? M, Alchin L, Nieweg O, Howle J, Coventry B; Cancer Council Australia Melanoma Guidelines Working Party. Clinical question: what are the recommended safety margins for radical excision of primary melanoma? In: Clinical Practice Guidelines for the Diagnosis and Management of Melanoma. Melanoma Institute Australia; February 18, 2020. 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