Surgical excision margins for primary cutaneous melanoma

Area of Science:

• Dermatology
• Surgical Oncology
• Clinical Trials

Background:

• Cutaneous melanoma is a significant cause of skin cancer mortality.
• Standard treatment involves surgical excision with safety margins to remove the primary tumor and potential spread.
• Optimal excision margin width remains unclear, impacting cosmetic outcomes and survival.

Purpose of the Study:

• To systematically review randomized controlled trials (RCTs) assessing the effects of different excision margin widths for primary cutaneous melanoma.

Main Methods:

• Conducted a systematic search of multiple databases for relevant RCTs up to August 2009.
• Included RCTs comparing different surgical excision margin widths for primary cutaneous melanoma.
• Assessed trial quality, extracted survival and recurrence data, and analyzed adverse effects.

Main Results:

• Five RCTs involving 1633 (narrow margin) and 1664 (wide margin) participants were identified.
• Narrow margins ranged from 1-2 cm; wide margins ranged from 3-5 cm, with median follow-up of 5-16 years.
• No statistically significant difference in overall survival or recurrence-free survival between narrow and wide excision margins was found.

Conclusions:

• Current evidence from five RCTs does not show a statistically significant difference in overall survival between narrow and wide excision margins.
• While summary estimates slightly favored wide excision for survival and recurrence-free survival, these differences were not statistically significant.
• Existing randomized trial evidence is insufficient to definitively establish optimal excision margins for primary cutaneous melanoma.