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February 3, 1993

Excision Margins for Melanoma in Awkward Places Like the Eyelid-Reply

Author Affiliations

University of Rochester (NY) School of Medicine and Dentistry

JAMA. 1993;269(5):588-589. doi:10.1001/jama.1993.03500050066020

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In Reply.  —We respond to Dr Reifler's letter from two perspectives—that of the chair of the NIH Consensus Conference on the diagnosis and treatment of early melanoma (L.A.G.), and that of a dermatologic surgeon (M.B.). We speak for ourselves and not for the consensus panel.The 1-cm margins for melanoma excision must be used thoughtfully. The dimensions are a guide rather than an absolute rule in regions in which there are functioning vital structures and where there are important cosmetic considerations. Therefore, in such sites as the eyelid, lip, glands, and penis, smaller margins may be used, but in such circumstances careful histological checking of the margins for tumor are imperative. Mohs' surgery has been suggested for those lesions although the interpretation of the histologic margins in those instances can be difficult.The behavior of melanoma has been studied in different anatomical sites, and although special behavior has been suggested