In a nutshell
The authors compared the effect of narrow and wide surgical margins on long-term survival of advanced melanoma patients. The authors found that for melanoma of 2 mm thickness or greater, the surgical margin should be 2 cm.
Some background
The standard treatment for skin cancer remains surgical removal of the tumor along with some of the surrounding normal skin. Removal of the normal skin is known as the safety margin, or surgical margin. Margins are intended to prevent relapse of cancer in the surrounding tissues.
It is still not clear whether the size of the surgical margin affects the spread of the disease. Studies have found that a narrow margin (1 cm) was associated with increased rates of recurrence over 5 years compared to a wider margin (3 cm). A long-term follow-up is needed to understand the effect of surgical margin on the outcomes of melanoma.
Methods & findings
The authors aimed to compare the effect of narrow surgical margins to wide surgical margins on long-term survival of melanoma patients.
900 patients with local melanoma 2 mm thick (how deep the tumor reaches into the skin) or greater were included in this study. 453 patients had surgery with a margin of 1 cm (group 1). 447 patients had surgery with a margin of 3 cm (group 2). The average time of follow-up was 8.8 years.
Survival rates were significantly lower in group 1 compared to group 2. 42.8% of patients in group 1 and 36.9% of patients in group 2 died from melanoma during the follow-up. Complications from surgery occurred in 7.7% of patients in group 1. This was compared to 14.5% of patients in group 2. Complications included loss of skin graft (skin transplanted from another area to replace skin lost during sugery) and rupture of the wound.
The bottom line
The authors concluded that for melanoma thickness of greater than 2 mm, a surgical margin of 1 cm was not enough. The authors suggested a margin of at least 2 cm should be required.
Published By :
The Lancet. Oncology
Date :
Jan 11, 2016
