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

Hudson, Laura; Maithel, Shishir K.; Carlson, Grant W.; Rizzo, M.; Murray, Douglas R.; Hestley, Andrea; Delman, Keith A.

doi:10.1245/s10434-012-2543-8

Cited by 41 publications

(32 citation statements)

References 11 publications

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“…23 Several prior studies have shown that widening surgical margins in melanomas between 1mm-4mm in thickness decreases the rate of loco-regional failure, but does not impact survival. 26, 27 Other clinical trials have shown that widening surgical margins does not improve local control of primary invasive melanoma. 28–33 All of these studies, however, exclude ALM.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Recurrence Patterns in Acral Versus Nonacral Melanoma: Should Histologic Subtype Influence Treatment Guidelines?

Gumaste¹,

Fleming²,

Silva³

et al. 2014

J Natl Compr Canc Netw

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Background Current surgical treatment of primary melanoma is uniform for all histo-subtypes, although certain types of melanoma, such as acral lentiginous melanoma (ALM), carry a poor prognosis. No study has explored the effectiveness of standard melanoma treatment guidelines in ALM compared to non-acral melanoma (NAM). Methods Study subjects were identified from a prospectively enrolled database of primary melanoma patients at Blinded for Review Purposes. ALM patients were matched to NAM patients (1:3) by gender and melanoma stage, including substage (ALM=61, NAM=183). All patients received standard of care treatment. Recurrence and survival outcomes in both cohorts were compared. Results ALM histologic subtype was an independent negative predictor of recurrence-free survival (HR = 2.45, p < 0.001) and melanoma-specific survival (HR= 2.64, p = 0.001) compared to NAM. Recurrence was significantly more common in ALM compared to NAM (49% versus 30%, p=0.007). In tumors less than 2mm in thickness, there was a significantly higher recurrence rate in ALM versus NAM (p=0.048). There was no significant difference in recurrence in tumors greater than 2mm (p= 0.12). Of note, the rate of loco-regional recurrence was nearly double in ALM compared to NAM (p=0.001). Conclusions Our data revealed a high rate of loco-regional failure in ALM compared to NAM when controlling for AJCC stage. Our results question whether ALM may require more aggressive surgical treatment than non- acral cutaneous melanomas of equal thickness, particularly in tumors less than 2mm thick. Revision of surgical margin recommendations based on larger multicenter cohorts may need to be considered.

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Section: Discussionmentioning

confidence: 99%

Analysis of Recurrence Patterns in Acral Versus Nonacral Melanoma: Should Histologic Subtype Influence Treatment Guidelines?

Gumaste¹,

Fleming²,

Silva³

et al. 2014

J Natl Compr Canc Netw

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“…[1][2][3][4] Balancing cosmesis, function, and morbidity with oncologic outcomes requires careful decision-making with respect to determination of the appropriate margins. 5 Inadequate excision margins increase the risk of local recurrence. 6 Conversely, unnecessarily large margins of excision generate greater morbidity and increased costs.…”

mentioning

confidence: 99%

A retrospective study of 1- versus 2-cm excision margins for cutaneous malignant melanomas thicker than 2 mm

Hunger

Angermeier

Jafari

et al. 2015

Journal of the American Academy of Dermatology

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“…Best discretion refers to the surgeon using a narrow margin to preserve functionality and cosmesis or avoid a potential need for skin graft or flap reconstruction. A more recent single-center, retrospective series directly compared outcomes for a 1 to 2 mm melanoma using a 1 or 2 cm margin width [11]. Hudson et al retrospectively reviewed 576 patients with 224 (38.9%) having a 1 cm margin and 352 (61.1%) having a 2 cm margin width.…”

Section: Introductionmentioning

confidence: 99%

Is a Wider Margin (2 cm vs. 1 cm) for a 1.01–2.0 mm Melanoma Necessary?

et al. 2016

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Background The current NCCN recommendation for resection margins in patients with melanomas between 1.01–2 mm deep is a 1–2 cm radial margin. We sought to determine if margin width had an impact on local recurrence (LR), disease-specific survival (DSS), and type of wound closure. Methods 1.01–2.0 mm melanomas were evaluated at a single institution between 2008 and 2013. All patients had a 1 or 2 cm margin. Results We identified 965 patients that had a 1 cm (n=302, 31.3%) or 2 cm margin (n=663, 68.7%). Median age was 64 and 592 (61.3%) were male. 32.5% and 48.7% of head and neck and extremity patients had a 1 cm margin vs. 18.9% of trunk pts (p<0.001). LR was 0.6% and 1.5% for a 1 and 2 cm margin, respectively (p=NS). Five-year DSS was 87% for a 1 cm margin and 85% for a 2 cm margin (p=NS). Breslow thickness, melanoma on the head and neck, lymphovascular invasion (LVI) and sentinel lymph node biopsy (SLNB) status significantly predicted LR on univariate analysis, however only location and SLNB status were associated with LR on multivariate analysis. Margin width was not significant for LR or DSS. Wider margins were associated with more frequent graft or flap use only on the head and neck (p=0.025). Conclusions Our data show selectively using a narrow margin of 1 cm did not increase the risk of local recurrence or decrease DSS. Avoiding a 2 cm margin may decrease the need for graft/flap use on the head and neck.

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

Abstract: 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.

Cited by 41 publications

References 11 publications

Analysis of Recurrence Patterns in Acral Versus Nonacral Melanoma: Should Histologic Subtype Influence Treatment Guidelines?

Analysis of Recurrence Patterns in Acral Versus Nonacral Melanoma: Should Histologic Subtype Influence Treatment Guidelines?

A retrospective study of 1- versus 2-cm excision margins for cutaneous malignant melanomas thicker than 2 mm

Is a Wider Margin (2 cm vs. 1 cm) for a 1.01–2.0 mm Melanoma Necessary?

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