title: Mayo Clinic consensus recommendations for the depth of excision in primary cutaneous melanoma.
abstract: Currently, no data from randomized controlled clinical trials are available to guide the depth of resection for intermediate-thickness primary cutaneous melanoma. Thus, we hypothesized that substantial variability exists in this aspect of surgical care. We have summarized the literature regarding depth of resection and report the results of our survey of surgeons who treat melanoma. Most of the 320 respondents resected down to, but did not include, the muscular fascia (extremity, 71%; trunk, 66%; and head and neck, 62%). However, significant variation exists. We identified variability in our own practice and have elected to standardize this common aspect of routine surgical care across our institution. In light of the lack of evidence to support resection of the deep muscular fascia, we have elected to preserve the muscular fascia as a matter of routine, except when a deep primary melanoma or thin subcutaneous tissue dictates otherwise.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Travis E
authors.initials: TE
authors.lastname: Grotz
authors.forename: Svetomir N
authors.initials: SN
authors.lastname: Markovic
authors.forename: Lori A
authors.initials: LA
authors.lastname: Erickson
authors.forename: William S
authors.initials: WS
authors.lastname: Harmsen
authors.forename: Marianne
authors.initials: M
authors.lastname: Huebner
authors.forename: David R
authors.initials: DR
authors.lastname: Farley
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Pockaj
authors.forename: John H
authors.initials: JH
authors.lastname: Donohue
authors.forename: Franklin H
authors.initials: FH
authors.lastname: Sim
authors.forename: Clive S
authors.initials: CS
authors.lastname: Grant
authors.forename: Sanjay P
authors.initials: SP
authors.lastname: Bagaria
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Shives
authors.forename: Charles M
authors.initials: CM
authors.lastname: Balch
authors.forename: James W
authors.initials: JW
authors.lastname: Jakub
mesh_terms: D001130:Arizona; D002986:Clinical Trials as Topic; D005431:Florida; D019538:Health Care Surveys; D006801:Humans; D008545:Melanoma / Q000473:pathology* / Q000601:surgery*; D008910:Minnesota; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000379:methods