Narrow excision (1-cm margin). A safe procedure for thin cutaneous melanoma

Area of Science:

• Dermatology
• Surgical Oncology
• Oncology

Background:

• Melanoma treatment guidelines recommend surgical excision.
• Optimal margin width for primary melanomas remains a subject of research.
• Previous studies suggested wider margins may improve outcomes.

Purpose of the Study:

• To evaluate the efficacy of 1-cm-margin excision versus wider excision for primary melanomas.
• To assess disease-free and overall survival rates at 8 years.
• To analyze local recurrence rates based on excision margin width.

Main Methods:

• International, randomized, prospective study by the World Health Organization Melanoma Programme.
• 612 patients with primary melanomas ≤ 2 mm thick.
• Randomization to 1-cm-margin excision (305 patients) or wide excision ≥ 3 cm (307 patients).

Main Results:

• No significant difference in disease-free or overall survival between narrow (1 cm) and wide (≥ 3 cm) excision groups.
• Mean follow-up of 90 months.
• Only four local recurrences observed, all in patients with melanomas > 1 mm treated with narrow excision.

Conclusions:

• 1-cm-margin excision is a safe and effective treatment for primary melanomas ≤ 2 mm thick.
• Wider excision margins do not appear to improve survival outcomes for these melanomas.
• Narrow excision may be considered for thinner melanomas, but caution is advised for melanomas > 1 mm.