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.
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References
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.
Cascinelli N. Margin of resection in the management of primary melanoma. Semin Surg Oncol. 1998;14:272–5.
National Comprehensive Cancer Network (U.S.), Journal of the national comprehensive cancer network: JNCCN. 2003, Jones and Bartlett: Sudbury.
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.
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.
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.
Tsao H, Atkins MB, Sober AJ. Management of cutaneous melanoma. N Engl J Med. 2004;351:998–1012.
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.
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.
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.
Thompson JF, Ollila DW. Optimum excision margins for melanoma. Lancet. 2011;378:1608–10.
Ott PA, Berman RS. Surgical approach to primary cutaneous melanoma. Surg Oncol Clin N Am. 2011;20:39–56.
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.
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Hudson, L.E., Maithel, S.K., Carlson, G.W. et al. 1 or 2 cm Margins of Excision for T2 Melanomas: Do They Impact Recurrence or Survival?. Ann Surg Oncol 20, 346–351 (2013). https://doi.org/10.1245/s10434-012-2543-8
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DOI: https://doi.org/10.1245/s10434-012-2543-8