Optimal surgical excision margins for primary cutaneous melanoma?

January 01, 0001

Optimal surgical excision margins for primary cutaneous melanoma?

Optimum surgical resection margins for patients with clinical stage IIA—C cutaneous melanoma thicker than 2 mm are controversial. The aim of the study was to test whether survival was different for a wide local excision margin of 2 cm compared with a 4-cm excision margin. he researchers undertook a randomised controlled trial in nine European centres. Patients with cutaneous melanoma thicker than 2 mm, at clinical stage IIA—C, were allocated to have either a 2-cm or a 4-cm surgical resection margin. Patients were randomised in a 1:1 allocation to one of the two groups and stratified by geographic region. 936 patients were enrolled from January 1992 to May 2004; 465 were randomly allocated to treatment with a 2-cm resection margin, and 471 to receive treatment with a 4-cm resection margin.

After a median follow-up of 6.7 years 181 patients in the 2- cm margin group and 177 in the 4-cm group had died (hazard ratio 1.05). 5-year overall survival was 65% in the 2-cm group and 65% in the 4-cm group.

The researchers concluded: "Our findings suggest that a 2-cm resection margin is sufficient and safe for patients with cutaneous melanoma thicker than 2 mm."

How does a GP know the depth prior to excision, or is the point that a 2cm excision margin is adequate for all primary cutaneous melanomas?

For the full abstract, click here.

The Lancet 378(9803):1635-1642, 5 November 2011 © 2011 Elsevier Limited
2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: a randomised, multicentre trial. Peter Gillgren, Krzysztof T Drzewiecki , Marianne Niin et al. Correspondence to Peter Gillgren: peter.gillgren@sodersjukhuset.se

Category: S. Skin. Keywords: surgical, excision, margins, cutaneous, melanoma, randomised multicentre trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 18 NOvember 2011

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