title: Long term results of a randomized study by the Swedish Melanoma Study Group on 2-cm versus 5-cm resection margins for patients with cutaneous melanoma with a tumor thickness of 0.8-2.0 mm.
abstract: BACKGROUND
  Large, prospective, randomized trials with long term follow-up are required to obtain an unbiased evaluation of the significance of resection margins in patients with cutaneous melanoma.
  
  
  METHODS
  The Swedish Melanoma Study Group performed a prospective, randomized, multicenter study of patients with primary melanoma located on trunk or extremities and with a tumor thickness > 0.8 mm and </= 2 mm. Patients were allocated randomly to a 2-cm excision margin or a 5-cm excision margin. In total, 989 patients were recruited during the period 1982-1991. The median follow-up was 11 years (range, 7-17 years) for estimation of survival and 8 years (range, 0-17 years) for evaluation of recurrent disease.
  
  
  RESULTS
  The crude rate of local recurrence, defined as a recurrence in the scar or transplant, was < 1% (8 of 989 patients). Twenty percent of the patients (194 of 989 patients) experienced any disease recurrence, and 15% (146 of 989 patients) died of melanoma. There were no statistically significant differences between the two treatment arms. In a multivariate Cox analysis with patients allocated to wide excision as the reference group, the estimated relative hazards for overall survival and recurrence free survival among those allocated to a 2-cm resection margin were 0.96 (95% confidence interval, 0.75-1.24), and 1.02 (95% confidence interval, 0.80-1.30), respectively.
  
  
  CONCLUSIONS
  In this long term follow-up study, local recurrences were found to be rare among patients with tumors > 0.8 mm thick and </= 2.0 mm thick. No difference in recurrence rate or survival between the two treatment groups was found. Patients in this category can be treated with a resection margin of 2 cm as safely as with a resection margin of 5 cm.
authors.affiliation: Department of Oncology-Pathology, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden. gabriella.cohn-cedermark@ks.se
authors.forename: G
authors.initials: G
authors.lastname: Cohn-Cedermark
authors.forename: L E
authors.initials: LE
authors.lastname: Rutqvist
authors.forename: R
authors.initials: R
authors.lastname: Andersson
authors.forename: M
authors.initials: M
authors.lastname: Breivald
authors.forename: C
authors.initials: C
authors.lastname: Ingvar
authors.forename: H
authors.initials: H
authors.lastname: Johansson
authors.forename: P E
authors.initials: PE
authors.lastname: Jönsson
authors.forename: L
authors.initials: L
authors.lastname: Krysander
authors.forename: C
authors.initials: C
authors.lastname: Lindholm
authors.forename: U
authors.initials: U
authors.lastname: Ringborg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis