title: 1 or 2 cm margins of excision for T2 melanomas: do they impact recurrence or survival?
abstract: BACKGROUND
  NCCN guidelines recommend 1 or 2 cm margins for melanomas 1-2 mm (T2 melanomas) in depth; however, no head-to-head comparison has been performed. We hypothesized 1- or 2-cm margins would have similar local recurrence (LR) and overall survival (OS).
  
  
  METHODS
  An institutional database was queried for patients with 1.0-2.0 mm melanomas treated from July 1995 to January 2011. All had wide excision and sentinel lymph node biopsy. Patients without documented surgical margins or follow-up were excluded. Clinicopathologic and recurrence data were reviewed. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  Of 2,118 patients, 1,225 met study criteria. Of these, 576 had complete data: 224 (38.9%) had 1 cm margins and 352 (61.1%), 2 cm margins. Median follow-up was 38 months. Mean age was 52.6 years (range 11.3-86.7). Mean thickness was 1.27 and 1.48 mm (1 and 2 cm, respectively, p<0.001) with ulceration more common in the 2 cm group (12.3 and 21.3%, respectively; p=0.009). LR was 3.6 and 0.9% in the 1 cm versus 2 cm group, respectively (p=0.044). OS was 29.1 months with 1 cm and 43.7 months in the 2 cm group. On multivariate analysis, only head and neck location and nodal status were associated with overall survival.
  
  
  CONCLUSIONS
  In this series, 1 cm margins were associated with a small increase in LR that did not impact OS. This is concordant with the NCCN recommendations; however, a prospective, randomized trial would be optimal.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine & The Winship Cancer Institute, Atlanta, Georgia, USA.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Hudson
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.forename: Grant W
authors.initials: GW
authors.lastname: Carlson
authors.forename: Monica
authors.initials: M
authors.lastname: Rizzo
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Murray
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Hestley
authors.forename: Keith A
authors.initials: KA
authors.lastname: Delman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult