title: Minimum Safe Pathologic Excision Margins for Primary Cutaneous Melanomas (1-2 mm in Thickness): Analysis of 2131 Patients Treated at a Single Center.
abstract: OBJECTIVE
  This study was designed to determine the minimum safe pathologic excision margin for primary cutaneous melanomas 1.01-2.00-mm thick (T2) and to identify prognostic factors that influence survival in these patients.
  
  
  BACKGROUND
  Several studies have shown previously that "narrow" clinical excision margins (1-2 cm in vivo) are as safe as "wide" excision margins (4-5 cm) for management of primary T2 melanomas. However, pathologic margins are likely to be a better predictor of recurrence than clinical margins.
  
  
  METHODS
  Clinicopathologic and follow-up data for 2131 T2 melanoma patients treated at Melanoma Institute Australia between January 1992 and May 2012 were analyzed.
  
  
  RESULTS
  Of the 2131 patients, those who had a pathologic excision margin of <8 mm (equivalent to 1 cm in vivo) had poorer prognosis in terms of disease-free survival compared with the 8-16-mm group (equivalent to 1-2 cm in vivo; P = 0.044). When comparing 8-mm with 16-mm pathologic margins, no differences were observed in any of the survival outcomes. Only the deep margin proved to be an independent predictor of local and in-transit recurrence-free survival (P = 0.003) in all excision margin categories. Pathologic excision margins <8 mm were associated with worse regional node recurrence-free survival and distant recurrence-free survival compared with margins ≥8 mm (P = 0.049 and P = 0.045; respectively). However, these results failed to translate into a statistically significant difference in melanoma-specific survival.
  
  
  CONCLUSIONS
  The results of this study suggest that if a peripheral/radial pathologic excision margin for a T2 primary cutaneous melanoma is <8 mm consideration should be given to performing a wider excision.
authors.affiliation: Melanoma Institute Australia, North Sydney, NSW, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Haydu
authors.affiliation: Melanoma Institute Australia, North Sydney, NSW, Australia.
authors.forename: Joram T
authors.initials: JT
authors.lastname: Stollman
authors.affiliation: Melanoma Institute Australia, North Sydney, NSW, Australia.|Discipline of Pathology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.|Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Scolyer
authors.affiliation: Melanoma Institute Australia, North Sydney, NSW, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Spillane
authors.affiliation: Melanoma Institute Australia, North Sydney, NSW, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Quinn
authors.affiliation: Melanoma Institute Australia, North Sydney, NSW, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Robyn P M
authors.initials: RP
authors.lastname: Saw
authors.affiliation: Melanoma Institute Australia, North Sydney, NSW, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Kerwin F
authors.initials: KF
authors.lastname: Shannon
authors.affiliation: Melanoma Institute Australia, North Sydney, NSW, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Stretch
authors.affiliation: Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Bonenkamp
authors.affiliation: Melanoma Institute Australia, North Sydney, NSW, Australia. john.thompson@melanoma.org.au.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. john.thompson@melanoma.org.au.
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
mesh_terms: D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D000096142:Cutaneous Malignant Melanoma