Journal Article

Excision Margins in High-Risk Malignant Melanoma

Fallowfield, Mary, Thomas, J. Meirion, Cook, Martin, O'Neill, Trevor, Timmons, Michael, Coombes, Gill, A'Hern, Roger, Theaker, Jeffery, Evans, Judy, Bliss, Judith M, Ruka, Wlodek, Newton-Bishop, Julia

2004

Overview

This randomized trial investigated the influence of the width of the margin of the surgical excision (1 cm or 3 cm) on the risk of recurrence and death in patients with high-risk cutaneous melanoma (as defined by a tumor thickness of 2 mm or more). A 1-cm margin was associated with a higher risk of locoregional recurrence than was a 3-cm margin, but three years after surgical treatment, overall survival was similar in the two groups. This randomized trial assessed the margin of the surgical excision (1cm or 3 cm) and the risk of recurrence. The risk of death from cutaneous melanoma is determined mainly by the thickness of the tumor, as described by Breslow, 1 the presence or absence of tumor ulceration and microdeposits of melanoma in sentinel lymph nodes, 2 , 3 the site of the tumor, and the patient's sex. 4 Spread occurs by lymphatic and hematogenous routes. Micrometastases from primary tumors migrate through cutaneous lymphatics to the regional lymph nodes. Traditionally, wide margins of excision have been used to prevent lymphatic spread, but over the past decade, margins have become smaller because previous trials have suggested that narrower margins are safe. 5 – 7 The issue remains . . .

• Publisher: Massachusetts Medical Society
• Subject: Adolescent / Adult / Aged / Aged, 80 and over / Biological and medical sciences / Clinical trials / Dermatology / Disease-Free Survival / Female / Follow-Up Studies / General aspects / Health risk assessment / Humans / Life Tables / Male / Medical disorders / Medical sciences / Melanoma - mortality / Melanoma - pathology / Melanoma - surgery / Middle Aged / Neoplasm Recurrence, Local - epidemiology / Prognosis / Proportional Hazards Models / Risk / Skin Neoplasms - mortality / Skin Neoplasms - pathology / Skin Neoplasms - surgery / Surgery / Surgical Procedures, Operative - methods / Survival Rate / Tumors / Tumors of the skin and soft tissue. Premalignant lesions