Excision of fascia in melanoma thicker than 2 mm: no evidence for improved clinical outcome

Hunger, Robert E.; Jafari, S. Morteza Seyed; Angermeier, Sarina; Shafighi, Maziar

doi:10.1111/bjd.13478

Cited by 16 publications

(19 citation statements)

References 21 publications

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“…In a single‐centre retrospective review of 1587 patients with melanomas 2.01–4.00 mm thick, histological margins ≥ 8 mm (equivalent to a ≥ 1 cm surgical margin) were associated with increased local and in‐transit recurrence‐free survival and disease‐free survival compared with a < 8 mm margin 20 . Another retrospective single‐centre cohort study of 325 patients with melanomas > 2 mm thick evaluating 1 cm or 2 cm excision margins showed no significant differences in loco‐regional and distant metastasis, disease‐free survival and overall survival between the groups 21 …”

Section: Results and Recommendationsmentioning

confidence: 97%

“…[10][11][12][13][14][15] There have also been several large published case series that provide further data. [16][17][18][19][20][21][22] No RCTs have assessed depth of excision. Recent non-randomised studies suggest that excision of the deep fascia does not improve the outcome for melanomas thicker than 1 mm 23 or 2 mm; 21 however, results of these retrospective studies must be interpreted with caution.…”

Section: Results and Recommendationsmentioning

confidence: 99%

“…[16][17][18][19][20][21][22] No RCTs have assessed depth of excision. Recent non-randomised studies suggest that excision of the deep fascia does not improve the outcome for melanomas thicker than 1 mm 23 or 2 mm; 21 however, results of these retrospective studies must be interpreted with caution. The depth of excision in usual clinical practice is excision down to but not including the deep fascia, unless the fascia is involved with tumour or if removal of it is technically warranted.…”

Section: Results and Recommendationsmentioning

confidence: 99%

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Updated evidence‐based clinical practice guidelines for the diagnosis and management of melanoma: definitive excision margins for primary cutaneous melanoma

Sladden

Nieweg

Howle

et al. 2018

Medical Journal of Australia

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Introduction: Definitive management of primary cutaneous melanoma consists of surgical excision of the melanoma with the aim of curing the patient. The melanoma is widely excised together with a safety margin of surrounding skin and subcutaneous tissue, after the diagnosis and Breslow thickness have been established by histological assessment of the initial excision biopsy specimen. Sentinel lymph node biopsy should be discussed for melanomas ≥ 1 mm thickness (≥ 0.8 mm if other high risk features) in which case lymphoscintigraphy must be performed before wider excision of the primary melanoma site. The 2008 evidence‐based clinical practice guidelines for the management of melanoma (http://www.cancer.org.au/content/pdf/HealthProfessionals/ClinicalGuidelines/ClinicalPracticeGuidelines-ManagementofMelanoma.pdf) are currently being revised and updated in a staged process by a multidisciplinary working party established by Cancer Council Australia. The guidelines for definitive excision margins for primary melanomas have been revised as part of this process. Main recommendations: The recommendations for definitive wide local excision of primary cutaneous melanoma are: melanoma in situ: 5–10 mm margins invasive melanoma (pT1) ≤ 1.0 mm thick: 1 cm margins invasive melanoma (pT2) 1.01–2.00 mm thick: 1–2 cm margins invasive melanoma (pT3) 2.01–4.00 mm thick: 1–2 cm margins invasive melanoma (pT4) > 4.0 mm thick: 2 cm margins Changes in management as a result of the guideline: Based on currently available evidence, excision margins for invasive melanoma have been left unchanged compared with the 2008 guidelines. However, melanoma in situ should be excised with 5–10 mm margins, with the aim of achieving complete histological clearance. Minimum clearances from all margins should be assessed and stated. Consideration should be given to further excision if necessary; positive or close histological margins are unacceptable.

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Section: Results and Recommendationsmentioning

confidence: 97%

Section: Results and Recommendationsmentioning

confidence: 99%

Section: Results and Recommendationsmentioning

confidence: 99%

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Updated evidence‐based clinical practice guidelines for the diagnosis and management of melanoma: definitive excision margins for primary cutaneous melanoma

Sladden

Nieweg

Howle

et al. 2018

Medical Journal of Australia

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“…When carrying out a wide local excision, the excised specimen should extend down to the level of the underlying muscular fascia. Currently, there is no evidence to suggest that excising the underlying fascia leads to improved outcome (2).…”

Section: Surgical Treatment Of Localized Diseasementioning

confidence: 99%

Surgical Management of Melanoma

Joyce

2017

Cutaneous Melanoma: Etiology and Therapy

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This chapter discusses the surgical principles in the management of melanoma. Surgery remains the mainstay of treatment of primary melanoma, and in the majority of cases it is curative. Appropriate surgical management is critical for the diagnosis, staging, and optimal treatment of both in situ and invasive primary cutaneous melanoma. Surgical management is dependent on the stage of the disease, and therefore this chapter evaluates localized, regional, and metastatic disease. The concept of sentinel lymph node biopsy is discussed along with its benefits, pitfalls, and prognostic significance. Furthermore, several important surgical issues are discussed, including the extent of surgical margins, Mohs micrographic surgery for melanoma in situ, and the role of metastasectomy.

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“…D ear E ditor , We appreciate the interest from and comments by Dr Naldi about our work recently published in the BJD , which suggested that preservation of the deep fascia in melanomas thicker than 2 mm (excised with a 1‐cm excision margin) is safe and results in a similar outcome to fascia excision …”

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confidence: 99%

Lack of strong evidence with regard to the depth of thick melanoma excision

2015

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Excision of fascia in melanoma thicker than 2 mm: no evidence for improved clinical outcome

Abstract: We believe that excision of the deep fascia does not improve the outcome of melanomas thicker than 2 mm.

Cited by 16 publications

References 21 publications

Updated evidence‐based clinical practice guidelines for the diagnosis and management of melanoma: definitive excision margins for primary cutaneous melanoma

Updated evidence‐based clinical practice guidelines for the diagnosis and management of melanoma: definitive excision margins for primary cutaneous melanoma

Surgical Management of Melanoma

Lack of strong evidence with regard to the depth of thick melanoma excision

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