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01-07-2016 | Melanomas

Is a Wider Margin (2 cm vs. 1 cm) for a 1.01–2.0 mm Melanoma Necessary?

Authors: Matthew P. Doepker, MD, Zachary J. Thompson, PhD, Kate J. Fisher, MA, Maki Yamamoto, MD, Kevin W. Nethers, MS, Jennifer N. Harb, MD, Matthew A. Applebaum, MS, Ricardo J. Gonzalez, MD, Amod A. Sarnaik, MD, Jane L. Messina, MD, Vernon K. Sondak, MD, Jonathan S. Zager, MD, FACS

Published in: Annals of Surgical Oncology | Issue 7/2016

ABSTRACT

Background

The current NCCN recommendation for resection margins in patients with melanomas between 1.01 and 2 mm deep is a 1–2 cm radial margin. We sought to determine whether margin width had an impact on local recurrence (LR), disease-specific survival (DSS), and type of wound closure.

Methods

Melanomas measuring 1.01–2.0 mm were evaluated at a single institution between 2008 and 2013. All patients had a 1 or 2 cm margin.

Results

We identified 965 patients who had a 1 cm (n = 302, 31.3 %) or 2 cm margin (n = 663, 68.7 %). Median age was 64 years, and 592 (61.3 %) were male; 32.5 and 48.7 % of head and neck and extremity patients had a 1 cm margin versus 18.9 % of trunk patients (p < 0.001). LR was 2.0 and 2.1 % for a 1 and 2 cm margin, respectively (p = not significant). Five-year DSS was 87 % for a 1 cm margin and 85 % for a 2 cm margin (p = not significant). Breslow thickness, melanoma on the head and neck, lymphovascular invasion, and sentinel lymph node biopsy (SLNB) status significantly predicted LR on univariate analysis; however, only location and SLNB status were associated with LR on multivariate analysis. Margin width was not significant for LR or DSS. Wider margins were associated with more frequent graft or flap use only on the head and neck (p = 0.025).

Conclusions

Our data show that selectively using a narrower margin of 1 cm did not increase the risk of LR or decrease DSS. Avoiding a 2 cm margin may decrease the need for graft/flap use on the head and neck.

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Title: Is a Wider Margin (2 cm vs. 1 cm) for a 1.01–2.0 mm Melanoma Necessary?
Authors: Matthew P. Doepker, MD
Zachary J. Thompson, PhD
Kate J. Fisher, MA
Maki Yamamoto, MD
Kevin W. Nethers, MS
Jennifer N. Harb, MD
Matthew A. Applebaum, MS
Ricardo J. Gonzalez, MD
Amod A. Sarnaik, MD
Jane L. Messina, MD
Vernon K. Sondak, MD
Jonathan S. Zager, MD, FACS
Publication date: 01-07-2016
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 7/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-016-5167-6

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Is a Wider Margin (2 cm vs. 1 cm) for a 1.01–2.0 mm Melanoma Necessary?

ABSTRACT

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

ABSTRACT

Background

Methods

Results

Conclusions

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