Abstract
Background: In the past, radical margins of excision were prescribed for cutaneous melanoma based on preconceived notions rather than on hard clinical evidence.
Methods: In a prospective study of 742 patients with intermediate-thickness melanoma (1–4 mm), 470 patients with trunk or proximal extremity lesions were randomized into a 2-or 4-cm margin. Patients with distal extremity or head and neck lesions (n=272) received uniformly a 2-cm margin.
Results: The overall rate of local recurrence was 3.8%. This rate in the randomized portion (n=470) was 2.1% for the 2-cm margin and 2.6% for the 4-cm margin (p=0.72). A progressive increase in local recurrence rates was observed with thickness: 2.3% for lesions 1.0–2.0 mm, 4.2% for those 2.01–3.0 mm, and 11.7% for those 3.01–4.0 mm thick (p=0.001). Local recurrence occurred in 1.5% of those without ulceration and in 10.6% of those with ulceration of the primary lesion (p=0.001). The local recurrence rate was not significantly affected by the margin of resection even among the thicker or ulcerated lesions. It also was not affected significantly by the method of closure of the primary site or management of the regional nodes, or the age or gender of the patients.
Conclusions: A 2-cm margin is as effective as a 4-cm margin in local control and survival of intermediate-thickness melanomas. The local recurrence rate is significantly affected by the thickness of the primary lesion and the presence or not of ulceration.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Balch CM, Urist MM, Karakousis CP, et al. Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1 to 4 mm). Results of a multi-institutional randomized surgical trial.Ann Surg 1993;218:262–9.
Kaplan EL, Meier P. Nonparametric estimation from incomplete observations.J Am Stat Assoc 1958;53:457–86.
Cox DR. Regression models and life tables.J R Stat Soc B 1971;34:187–220.
Boring CC, Squires TS, Tong T. Cancer statistics 1992.CA 1992;421:19–38.
Balch CM, Karakousis CP, Mettlin C, et al. Management of cutaneous melanoma in the United States.Surg Gynecol Obstet 1984;158:311–8.
Breslow A, Macht SK. Optimal size of resection margin for thin cutaneous melanoma.Surg Gynecol Obstet 1977;145:691–2.
Veronesi U, Cascinelli N, Adamus J, et al. Thin stage primary cutaneous malignant melanoma: comparison of excision with margins of 1 to 3 cm.N Engl J Med 1988;318:1159–62.
Veronesi U, Cascinelli N. Narrow excision (1-cm margin): a safe procedure for thin cutaneous melanoma.Arch Surg 1991;126:438–41.
Loree TR, Spiro RH. Cutaneous melanoma of the head and neck.Am J Surg 1989;158:388–91.
Urist MM, Balch CM. Head and neck melanoma. In: Balch CM, Houghton AN, Milton GW, Sober AJ, Soong S-J, eds.Cutaneous melanoma. 2nd ed. Philadelphia: JB Lippincott, 1992:295–301.
Ames FC, Balch CM, Reintgen D. Local recurrence and their management. In: Balch CM, Houghton AN, Milton GW, Sober AJ, Soong S-J, eds.Cutaneous melanoma. 2nd ed. Philadelphia: JB Lippincott, 1992:287–94.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Karakousis, C.P., Balch, C.M., Urist, M.M. et al. Local recurrence in malignant melanoma: Long-term results of the multiinstitutional randomized surgical trial. Annals of Surgical Oncology 3, 446–452 (1996). https://doi.org/10.1007/BF02305762
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02305762