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Annals of Surgical Oncology

, Volume 23, Issue 4, pp 1071–1081 | Cite as

Minimum Safe Pathologic Excision Margins for Primary Cutaneous Melanomas (1–2 mm in Thickness): Analysis of 2131 Patients Treated at a Single Center

  • Lauren E. Haydu
  • Joram T. Stollman
  • Richard A. Scolyer
  • Andrew J. Spillane
  • Michael J. Quinn
  • Robyn P. M. Saw
  • Kerwin F. Shannon
  • Jonathan R. Stretch
  • Johannes J. Bonenkamp
  • John F. Thompson
Melanomas

Abstract

Objective

This study was designed to determine the minimum safe pathologic excision margin for primary cutaneous melanomas 1.01–2.00-mm thick (T2) and to identify prognostic factors that influence survival in these patients.

Background

Several studies have shown previously that “narrow” clinical excision margins (1–2 cm in vivo) are as safe as “wide” excision margins (4–5 cm) for management of primary T2 melanomas. However, pathologic margins are likely to be a better predictor of recurrence than clinical margins.

Methods

Clinicopathologic and follow-up data for 2131 T2 melanoma patients treated at Melanoma Institute Australia between January 1992 and May 2012 were analyzed.

Results

Of the 2131 patients, those who had a pathologic excision margin of <8 mm (equivalent to 1 cm in vivo) had poorer prognosis in terms of disease-free survival compared with the 8–16-mm group (equivalent to 1–2 cm in vivo; P = 0.044). When comparing 8-mm with 16-mm pathologic margins, no differences were observed in any of the survival outcomes. Only the deep margin proved to be an independent predictor of local and in-transit recurrence-free survival (P = 0.003) in all excision margin categories. Pathologic excision margins <8 mm were associated with worse regional node recurrence-free survival and distant recurrence-free survival compared with margins ≥8 mm (P = 0.049 and P = 0.045; respectively). However, these results failed to translate into a statistically significant difference in melanoma-specific survival.

Conclusions

The results of this study suggest that if a peripheral/radial pathologic excision margin for a T2 primary cutaneous melanoma is <8 mm consideration should be given to performing a wider excision.

Keywords

Melanoma Sentinel Lymph Node Biopsy National Comprehensive Cancer Network Primary Melanoma Breslow Thickness 
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

Acknowledgments

The authors gratefully acknowledge the assistance of colleagues at Melanoma Institute Australia and the Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia.

Supplementary material

10434_2015_4575_MOESM1_ESM.docx (91 kb)
Supplementary material 1 (DOCX 90 kb)

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Lauren E. Haydu
    • 1
    • 2
  • Joram T. Stollman
    • 1
  • Richard A. Scolyer
    • 1
    • 3
    • 4
  • Andrew J. Spillane
    • 1
    • 2
  • Michael J. Quinn
    • 1
    • 2
  • Robyn P. M. Saw
    • 1
    • 2
  • Kerwin F. Shannon
    • 1
    • 2
  • Jonathan R. Stretch
    • 1
    • 2
  • Johannes J. Bonenkamp
    • 5
  • John F. Thompson
    • 1
    • 2
  1. 1.Melanoma Institute AustraliaNorth SydneyAustralia
  2. 2.Discipline of Surgery, Sydney Medical SchoolThe University of SydneySydneyAustralia
  3. 3.Discipline of Pathology, Sydney Medical SchoolThe University of SydneySydneyAustralia
  4. 4.Tissue Pathology and Diagnostic OncologyRoyal Prince Alfred HospitalSydneyAustralia
  5. 5.Department of SurgeryRadboud University Nijmegen Medical CentreNijmegenThe Netherlands

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