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Narrow excision (1-cm margin). A safe procedure for thin cutaneous melanoma
1World Health Organization Melanoma Programme, National Tumor Institute, Milan, Italy.
Abstract:
We analyzed the results at 8 years of an international, randomized, prospective study carried out by the World Health Organization Melanoma Programme aimed at evaluating the efficacy of 1-cm-margin excision of primary melanomas not thicker than 2 mm. Data for 612 patients were assessable; 305 were randomized to receive 1-cm-margin excision and 307 to receive wide excision (margins of greater than or equal to 3 cm). The major prognostic criteria were similar in the two groups. Breslow thickness was 0.99 mm in the narrow excision group and 1.02 mm in the wide excision group. Disease-free and overall survival rates (mean follow-up period, 90 months) were similar in the two groups. Only four patients had a local recurrence as a first relapse. All underwent narrow excision, and each had primary melanomas thicker than 1 mm.
Insights
For primary melanomas under 2 mm thick, 1-cm-margin excision shows similar survival rates to wider excisions. Local recurrence was rare and primarily seen in thicker melanomas treated with narrow excision.
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.