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Recommended width of excision for primary malignant melanoma
1Department of Surgery, Mater Misericordiae Adult Public Hospital, Brisbane, Queensland, Australia.
World Journal of Surgery
|May 1, 1995
Summary
For nearly 140 years, wide local excision for melanoma used large margins. Current practice advocates for 1 cm excision margins for all melanoma stages, improving patient outcomes.
Area of Science:
- Dermatology
- Surgical Oncology
- Oncology
Background:
- Historically, wide local excision (3-5 cm margins) was standard for melanoma.
- Previous studies often did not differentiate by melanoma stage.
- Limited excision margins were later proposed by Breslow.
Purpose of the Study:
- To evaluate the efficacy of limited excision margins (1 cm) for all melanoma thicknesses.
- To challenge the long-standing 3-5 cm margin recommendation.
Main Methods:
- Retrospective review of melanoma cases treated with 1.00-1.50 cm (primarily 1 cm) excision margins since 1975.
- Analysis of locoregional recurrence rates and disease-specific mortality.
- Consideration of Clark's findings on vertical invasion patterns.
Main Results:
- Studies indicate no significant increase in locoregional recurrence with conservative margins.
- No significant change in melanoma-related death rates was observed with more conservative treatment.
- A 1 cm margin is advocated irrespective of tumor thickness.
Conclusions:
- A 1 cm excision margin is sufficient for melanomas of all thicknesses.
- Conservative margins do not negatively impact recurrence or mortality rates.
- Melanoma excision requires meticulous surgical technique in an operating room setting.