Thin stage I primary cutaneous malignant melanoma. Comparison of excision with margins of 1 or 3 cm.
Although wide surgical excision is the accepted treatment for thin malignant melanomas, there is reason to believe that narrower margins may be adequate. We conducted a randomized prospective study to assess the efficacy of narrow excision (excision with 1-cm margins) for primary melanomas no thicker than 2 mm. Narrow excision was performed in 305 patients, and wide excision (margins of 3 cm or more) was performed in 307 patients. The major prognostic criteria were well balanced in the two groups. The mean thickness of melanomas was 0.99 mm in the narrow-excision group and 1.02 mm in the wide-excision group. The subsequent development of metastatic disease involving regional nodes and distant organs was not different in the two groups (4.6 and 2.3 percent, respectively, in the narrow-excision group, as compared with 6.5 and 2.6 percent in the wide-excision group). Disease-free survival rates and overall survival rates (mean follow-up period, 55 months) were also similar in the two groups. Only three patients had a local recurrence as a first relapse. All had undergone narrow excision, and each had a primary melanoma with a thickness of 1 mm or more. The absence of local recurrence in the group of patients with a primary melanoma thinner than 1 mm and the very low rate of local recurrences indicate that narrow excision is a safe and effective procedure for such patients.
Veronesi
U
U
National Cancer Institute, Milan, Italy.
Cascinelli
N
N
Adamus
J
J
Balch
C
C
Bandiera
D
D
Barchuk
A
A
Bufalino
R
R
Craig
P
P
De Marsillac
J
J
Durand
J C
JC
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008722:Methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011897:Random Allocation; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*