title: Reducing margins of wide local excision in head and neck melanoma for function and cosmesis: 5-year local recurrence-free survival.
abstract: BACKGROUND
  The proximity of head and neck (H&N) melanomas to critical anatomical structures requires that surgeons achieve a balance between adequate margins of excision and the functional and cosmetic needs of patients. This study sought to determine the risk associated with reducing margins of wide local excision (WLE) in H&N melanoma and to identify risk factors of recurrence.
  
  
  METHODS
  Seventy-nine cases of primary, invasive H&N melanoma were treated by WLE and followed prospectively for local recurrence. Forty-two WLEs were performed according to current practice guidelines (1cm for lesions<1.0 mm thick, 1-2 cm for lesions 1.01-2.0 mm thick, and 2 cm for lesions >2.0 mm thick). Reduced margins (0.5 cm for lesions ≤1.0 mm thick, 0.5-1.0 cm for lesions 1.01-2.0 mm thick, and 1.0 cm for lesion >2.0 mm thick) were utilized in 37 cases to preserve critical anatomical structures such as the eyelid, nose, mouth and auricle.
  
  
  RESULTS
  Overall local recurrence rate was 8.9% over a mean follow-up period of 71.3 months and a minimum of 60 months. Reducing margins of WLE did not increase local recurrence rates as demonstrated by local recurrence-free survival (90.4% vs. 91.9%, P = 0.806).
  
  
  CONCLUSIONS
  Margins of WLE may be safely reduced in melanomas in close proximity to structures of the H&N without affecting local recurrence rates.
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Surgery, Chicago, Illinios.
authors.forename: Roshni
authors.initials: R
authors.lastname: Rawlani
authors.forename: Vinay
authors.initials: V
authors.lastname: Rawlani
authors.forename: Hannan A
authors.initials: HA
authors.lastname: Qureshi
authors.forename: John Ys
authors.initials: JY
authors.lastname: Kim
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Wayne
mesh_terms: D003358:Cosmetics; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D003358:Cosmetics
keywords: head and neck; melanoma; wide local excision