title: Is a Wider Margin (2 cm vs. 1 cm) for a 1.01-2.0 mm Melanoma Necessary?
abstract: The current NCCN recommendation for resection margins in patients with melanomas between 1.01 and 2 mm deep is a 1-2 cm radial margin. We sought to determine whether margin width had an impact on local recurrence (LR), disease-specific survival (DSS), and type of wound closure.
  
  
  
  Melanomas measuring 1.01-2.0 mm were evaluated at a single institution between 2008 and 2013. All patients had a 1 or 2 cm margin.
  
  
  
  We identified 965 patients who had a 1 cm (n = 302, 31.3 %) or 2 cm margin (n = 663, 68.7 %). Median age was 64 years, and 592 (61.3 %) were male; 32.5 and 48.7 % of head and neck and extremity patients had a 1 cm margin versus 18.9 % of trunk patients (p < 0.001). LR was 2.0 and  2.1 % for a 1 and 2 cm margin, respectively (p = not significant). Five-year DSS was 87 % for a 1 cm margin and 85 % for a 2 cm margin (p = not significant). Breslow thickness, melanoma on the head and neck, lymphovascular invasion, and sentinel lymph node biopsy (SLNB) status significantly predicted LR on univariate analysis; however, only location and SLNB status were associated with LR on multivariate analysis. Margin width was not significant for LR or DSS. Wider margins were associated with more frequent graft or flap use only on the head and neck (p = 0.025).
  
  
  
  Our data show that selectively using a narrower margin of 1 cm did not increase the risk of LR or decrease DSS. Avoiding a 2 cm margin may decrease the need for graft/flap use on the head and neck.
authors.affiliation: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Doepker
authors.affiliation: Department of Biostatistics, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Thompson
authors.affiliation: Department of Biostatistics, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Kate J
authors.initials: KJ
authors.lastname: Fisher
authors.affiliation: Department of Surgical Oncology, University of California, Irvine Medical Center, Orange, CA, USA.
authors.forename: Maki
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Nethers
authors.affiliation: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Harb
authors.affiliation: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Applebaum
authors.affiliation: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Gonzalez
authors.affiliation: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Amod A
authors.initials: AA
authors.lastname: Sarnaik
authors.affiliation: Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Messina
authors.affiliation: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Vernon K
authors.initials: VK
authors.lastname: Sondak
authors.affiliation: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA. Jonathan.zager@moffitt.org.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Zager
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D055815:Young Adult