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Erschienen in:
01.01.2013 | Melanomas
1 or 2 cm Margins of Excision for T2 Melanomas: Do They Impact Recurrence or Survival?
Erschienen in: Annals of Surgical Oncology | Ausgabe 1/2013
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Background
NCCN guidelines recommend 1 or 2 cm margins for melanomas 1–2 mm (T2 melanomas) in depth; however, no head-to-head comparison has been performed. We hypothesized 1- or 2-cm margins would have similar local recurrence (LR) and overall survival (OS).
Methods
An institutional database was queried for patients with 1.0–2.0 mm melanomas treated from July 1995 to January 2011. All had wide excision and sentinel lymph node biopsy. Patients without documented surgical margins or follow-up were excluded. Clinicopathologic and recurrence data were reviewed. Univariate and multivariate analyses were performed.
Results
Of 2,118 patients, 1,225 met study criteria. Of these, 576 had complete data: 224 (38.9 %) had 1 cm margins and 352 (61.1 %), 2 cm margins. Median follow-up was 38 months. Mean age was 52.6 years (range 11.3–86.7). Mean thickness was 1.27 and 1.48 mm (1 and 2 cm, respectively, p < 0.001) with ulceration more common in the 2 cm group (12.3 and 21.3 %, respectively; p = 0.009). LR was 3.6 and 0.9 % in the 1 cm versus 2 cm group, respectively (p = 0.044). OS was 29.1 months with 1 cm and 43.7 months in the 2 cm group. On multivariate analysis, only head and neck location and nodal status were associated with overall survival.
Conclusions
In this series, 1 cm margins were associated with a small increase in LR that did not impact OS. This is concordant with the NCCN recommendations; however, a prospective, randomized trial would be optimal.