Non-compliance with the re-excision guidelines for cutaneous melanoma in The Netherlands does not influence survival

Haniff, Jamaiyah; Vries, Esther de; Claassen, A.T.P.M.; Looman, Caspar W.N.; Berlo, Ch. van; Coebergh, Jan Willem

doi:10.1016/j.ejso.2005.09.009

Cited by 9 publications

(12 citation statements)

References 17 publications

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“…The evidence on which this is based predominantly focuses on disease affecting the trunk and limbs [12,19,20], and their value in head and neck disease remains unknown [11]. Evidence in this area is particularly useful given the limited scope to achieve the recommended margins in the head and neck region [2,15,17,18]. Five-year survival rates in whole cohort (%)…”

Section: Discussionmentioning

confidence: 99%

“…Five-year melanoma-specific survival and loco-regional recurrence of head and melanoma Head and neck melanoma has been shown to have a significantly poorer survival and increased recurrence rate than disease of the trunk and extremities [6,18,[20][21][22][23][24][25]. Quoted 5-year survival figures for head and neck melanoma include 65%, 70%, 77%, 82%, 85% and 85% [5,7,10,23,[26][27][28], and quoted loco-regional recurrence rates include 12%, 15%, 19%, 20%, 23% and 27% [2,4,5,26,28,29].…”

Section: Discussionmentioning

confidence: 99%

“…Whilst some authors report significantly poorer rates of recurrence and survival with non-adherence to the recommended margins [19,31], others have found that adherence to recommended margins is not the major factor in long-term survival [18,29,32]. Such data however is strongly trunk and limb specific, with either exclusion of head and neck cases [19] or partial representation of head and neck cases [17,18,32] (18% Table 4 Statistics for 5-year melanoma-specific survival and loco-regional recurrence data Each letter denotes a subset of tumour T stage categories whose column proportions do not differ significantly from each other at the 0.05 level Each letter denotes a subset of tumour T stage categories whose column proportions do not differ significantly from each other at the 0.05 level head and neck cases [17]; 12% head and neck cases [18]). Thus, their value in head and neck disease is not well understood [11].…”

Section: Adherence To Guidelinesmentioning

confidence: 99%

“…The current consensus is that 'narrower margins should be considered as very reasonable in all those areas where a 2-cm margin would meet with anatomical, functional or cosmetic constraints', though there is very little published data to support such recommendations [11,12]. As such, lateral excision margins in the head and neck region are often smaller [15,17,18], but we are uncertain of the exact effect this has on recurrence rates and survival.…”

Section: Introductionmentioning

confidence: 96%

“…In the head and neck region, however, excision of this amount of tissue is often not feasible, as it will substantially impair the form and function of the important adjacent structures [2,11,15,16]. Previous reports are of achievement of the desired margins in the range of 50-70% in this area [15,17,18]. The current consensus is that 'narrower margins should be considered as very reasonable in all those areas where a 2-cm margin would meet with anatomical, functional or cosmetic constraints', though there is very little published data to support such recommendations [11,12].…”

Section: Introductionmentioning

confidence: 97%

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Adherence to guideline excision margins in head and neck melanoma: the influence on 5-year survival and loco-regional recurrence

Robertson

Senior

et al. 2011

Eur J Plast Surg

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Guidelines for the management of cutaneous melanoma suggest wide local excision of increasing margins for increasing Breslow thickness of the primary neoplasm. These guidelines are based on randomized controlled trial data from limb and trunk melanoma studies. We performed retrospective analysis of our institution's head and neck melanoma database to investigate the effect of narrow excision margins on survival and loco-regional recurrence. We identified 101 patients with node-negative head and neck melanoma from 1993 to 2001 who had prospectively gathered data. The overall 5-year loco-regional recurrence rate (LR) was 37%. The overall 5-year melanoma-specific survival rate (5y.s.) was 70%. When guidelines were followed (n036), LR was 19% and 5y.s. was 89%. When guidelines were not followed (n065), LR was 46% and 5y.s. was 60%. On univariate analysis, we found scalp location (p<0.001), male gender (p<0.025), advanced tumour T stage (p<0.005) and non-adherence to guidelines (p<0.003) were significantly associated with poorer 5y.s., whilst scalp location (p<0.004), advanced tumour T stage (p<0.030) and non-adherence to guidelines (p<0.010) were significantly associated with greater LR. On multivariate analysis, only scalp location (p<0.001; p<0.001) and advanced tumour T stage (p<0.020; p<0.014) remained significant predictors of 5y.s. and LR. We conclude it is often impossible to perform excision margins as recommended in published guidelines for cutaneous melanoma in the head and neck, given functional and aesthetic constraints. While such margins should be adhered to where possible, adherence is not the major factor in long-term recurrence and survival (level of evidence: IV).

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