Advertisement

Annals of Surgical Oncology

, Volume 20, Issue 1, pp 346–351 | Cite as

1 or 2 cm Margins of Excision for T2 Melanomas: Do They Impact Recurrence or Survival?

  • Laura E. Hudson
  • Shishir K. Maithel
  • Grant W. Carlson
  • Monica Rizzo
  • Douglas R. Murray
  • Andrea C. Hestley
  • Keith A. Delman
Melanomas

Abstract

Background

NCCN guidelines recommend 1 or 2 cm margins for melanomas 1–2 mm (T2 melanomas) in depth; however, no head-to-head comparison has been performed. We hypothesized 1- or 2-cm margins would have similar local recurrence (LR) and overall survival (OS).

Methods

An institutional database was queried for patients with 1.0–2.0 mm melanomas treated from July 1995 to January 2011. All had wide excision and sentinel lymph node biopsy. Patients without documented surgical margins or follow-up were excluded. Clinicopathologic and recurrence data were reviewed. Univariate and multivariate analyses were performed.

Results

Of 2,118 patients, 1,225 met study criteria. Of these, 576 had complete data: 224 (38.9 %) had 1 cm margins and 352 (61.1 %), 2 cm margins. Median follow-up was 38 months. Mean age was 52.6 years (range 11.3–86.7). Mean thickness was 1.27 and 1.48 mm (1 and 2 cm, respectively, p < 0.001) with ulceration more common in the 2 cm group (12.3 and 21.3 %, respectively; p = 0.009). LR was 3.6 and 0.9 % in the 1 cm versus 2 cm group, respectively (p = 0.044). OS was 29.1 months with 1 cm and 43.7 months in the 2 cm group. On multivariate analysis, only head and neck location and nodal status were associated with overall survival.

Conclusions

In this series, 1 cm margins were associated with a small increase in LR that did not impact OS. This is concordant with the NCCN recommendations; however, a prospective, randomized trial would be optimal.

Keywords

Melanoma Overall Survival National Comprehensive Cancer Network National Comprehensive Cancer Network Wide Local Excision 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

Thank you to Josh Josephs, MD/PhD Candidate, Class of 2012, Emory University School of Medicine and to Jeff Weaver, Emory University for data extraction.

References

  1. 1.
    Grotz TE, Markovic SN, Erickson LA, Harmsen WS, Huebner M, Farley DR, et al. Mayo clinic consensus recommendations for the depth of excision in primary cutaneous melanoma. Mayo Clin Proc. 2011;86:522–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Cascinelli N. Margin of resection in the management of primary melanoma. Semin Surg Oncol. 1998;14:272–5.PubMedCrossRefGoogle Scholar
  3. 3.
    National Comprehensive Cancer Network (U.S.), Journal of the national comprehensive cancer network: JNCCN. 2003, Jones and Bartlett: Sudbury.Google Scholar
  4. 4.
    Balch CM, Soong SJ, Smith T, Ross MI, Urist MM, Karakousis CP, et al. Long-term results of a prospective surgical trial comparing 2 cm vs. 4 cm excision margins for 740 patients with 1–4 mm melanomas. Ann Surg Oncol. 2001;8:101–8.PubMedGoogle Scholar
  5. 5.
    Khayat D, Rixe O, Martin G, Soubrane C, Banzet M, Bazex JA, et al. Surgical margins in cutaneous melanoma (2 cm versus 5 cm for lesions measuring less than 2.1-mm thick). Cancer. 2003;97:1941–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Cohn-Cedermark G, Rutqvist LE, Andersson R, Breivald M, Ingvar C, Johansson H, et al. Long term results of a randomized study by the Swedish Melanoma Study Group on 2-cm versus 5-cm resection margins for patients with cutaneous melanoma with a tumor thickness of 0.8–2.0 mm. Cancer. 2000;89:1495–501.PubMedCrossRefGoogle Scholar
  7. 7.
    Tsao H, Atkins MB, Sober AJ. Management of cutaneous melanoma. N Engl J Med. 2004;351:998–1012.PubMedCrossRefGoogle Scholar
  8. 8.
    Stucky CC, Gray RJ, Dueck AC, Wasif N, Laman SD, Sekulic A, et al. Risk factors associated with local and in-transit recurrence of cutaneous melanoma. Am J Surg. 2010;200:770–4; discussion 774–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–206.PubMedCrossRefGoogle Scholar
  10. 10.
    Balch CM, Buzaid AC, Soong SJ, Atkins MB, Cascinelli N, Coit DG, et al. Final version of the American joint committee on cancer staging system for cutaneous melanoma. J Clin Oncol. 2001;19:3635–48.PubMedGoogle Scholar
  11. 11.
    Thompson JF, Ollila DW. Optimum excision margins for melanoma. Lancet. 2011;378:1608–10.PubMedCrossRefGoogle Scholar
  12. 12.
    Ott PA, Berman RS. Surgical approach to primary cutaneous melanoma. Surg Oncol Clin N Am. 2011;20:39–56.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Laura E. Hudson
    • 1
  • Shishir K. Maithel
    • 1
  • Grant W. Carlson
    • 1
  • Monica Rizzo
    • 1
  • Douglas R. Murray
    • 1
  • Andrea C. Hestley
    • 1
  • Keith A. Delman
    • 1
  1. 1.Division of Surgical Oncology, Department of SurgeryEmory University School of Medicine & The Winship Cancer InstituteAtlantaGeorgia

Personalised recommendations