Annals of Surgical Oncology, Vol 3, Issue 5 446-452, Copyright © 1996 by Society of Surgical Oncology

ARTICLES

Local recurrence in malignant melanoma: long-term results of the multiinstitutional randomized surgical trial

C. P. Karakousis, C. M. Balch, M. M. Urist, M. M. Ross, T. J. Smith and A. A. Bartolucci
Department of Surgery, State University of New York, Buffalo, USA.

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 article has been cited by other articles:

				A. B. Francken, N. A. Accortt, H. M. Shaw, M. Wiener, S.-j. Soong, H. J. Hoekstra, and J. F. Thompson Prognosis and Determinants of Outcome Following Locoregional or Distant Recurrence in Patients with Cutaneous Melanoma Ann. Surg. Oncol., May 1, 2008; 15(5): 1476 - 1484. [Abstract] [Full Text] [PDF]

				M. B. Lens, P. Nathan, and V. Bataille Excision Margins for Primary Cutaneous Melanoma: Updated Pooled Analysis of Randomized Controlled Trials Arch Surg, September 1, 2007; 142(9): 885 - 891. [Abstract] [Full Text] [PDF]

				M. S. Brady, K. Brown, A. Patel, C. Fisher, and W. Marx A Phase II Trial of Isolated Limb Infusion With Melphalan and Dactinomycin for Regional Melanoma and Soft Tissue Sarcoma of the Extremity Ann. Surg. Oncol., August 1, 2006; 13(8): 1123 - 1129. [Abstract] [Full Text] [PDF]

				T. M. Pawlik, M. I. Ross, M. M. Johnson, C. W. Schacherer, D. M. McClain, P. F. Mansfield, J. E. Lee, J. N. Cormier, and J. E. Gershenwald Predictors and Natural History of In-Transit Melanoma After Sentinel Lymphadenectomy Ann. Surg. Oncol., August 1, 2005; 12(8): 587 - 596. [Abstract] [Full Text] [PDF]

				C. A. Charles, V. S. K. Yee, S. W. Dusza, A. A. Marghoob, S. A. Oliveria, A. Kopf, D. Rigel, and A. C. Halpern Variation in the Diagnosis, Treatment, and Management of Melanoma In Situ: A Survey of US Dermatologists Arch Dermatol, June 1, 2005; 141(6): 723 - 729. [Abstract] [Full Text] [PDF]

				U. Leiter, P. G. Buettner, T. K. Eigentler, and C. Garbe Prognostic Factors of Thin Cutaneous Melanoma: An Analysis of the Central Malignant Melanoma Registry of the German Dermatological Society J. Clin. Oncol., September 15, 2004; 22(18): 3660 - 3667. [Abstract] [Full Text] [PDF]

				T. M. Johnson and V. K. Sondak Melanoma Margins: The Importance and Need for More Evidence-Based Trials Arch Dermatol, September 1, 2004; 140(9): 1148 - 1150. [Full Text] [PDF]

				M. B. Lens, M. Dawes, T. Goodacre, and J. A. N. Bishop Excision Margins in the Treatment of Primary Cutaneous Melanoma: A Systematic Review of Randomized Controlled Trials Comparing Narrow vs Wide Excision Arch Surg, October 1, 2002; 137(10): 1101 - 1105. [Abstract] [Full Text] [PDF]

				H. Medina-Franco, M. M. Urist, J. Fiveash, M. J. Heslin, K. I. Bland, and S. W. Beenken Multimodality Treatment of Merkel Cell Carcinoma: Case Series and Literature Review of 1024 Cases Ann. Surg. Oncol., April 1, 2001; 8(3): 204 - 208. [Abstract] [Full Text] [PDF]

				C. M. Balch, S.-j. Soong, T. Smith, M. I. Ross, M. M. Urist, C. P. Karakousis, W. J. Temple, M. C. Mihm, R. L. Barnhill, W. R. Jewell, et al. Long-Term Results of a Prospective Surgical Trial Comparing 2 cm vs. 4 cm Excision Margins for 740 Patients With 1-4 mm Melanomas Ann. Surg. Oncol., March 1, 2001; 8(2): 101 - 108. [Abstract] [Full Text] [PDF]