Improved Melanoma-Specific Survival Reported With Wider Excision Margin in High-Risk Primary Melanoma
Wider excision margins in high-risk primary cutaneous melanoma were associated with improved melanoma-specific survival, according to long-term follow-up in a UK-led trial reported by Hayes et al in The Lancet Oncology. No significant improvement in overall survival was observed. The initial report from the trial showed that 1-cm margins were associated with an increased risk of local relapse vs 3-cm margins, with no apparent effect on survival.
Study Details
In the open-label trial, 900 patients with one primary localized cutaneous melanoma > 2 mm in Breslow thickness on the trunk or limbs from 57 sites in the United Kingdom, 1 in Poland, and 1 in South Africa were randomized between December 1992 and May 2001 to receive a 1-cm excision margin (n = 453) or a 3-cm excision margin (n = 447).
Survival
After a median follow-up of 8.8 years, death due to melanoma had occurred in 194 patients in the 1-cm group vs 165 in the 3-cm group (unadjusted hazard ratio [HR] = 1.24, P = .041), and death from any cause had occurred in 253 vs 241 (unadjusted HR = 1.14, P = .14). The estimated absolute difference in melanoma-specific survival at 10 years was 5.95% (95% confidence interval [CI] = –0.54 to 12.44). Multivariate analysis yielded similar results for melanoma-specific survival (HR = 1.28, P = .031) and overall survival (HR = 1.19, P = .070). Surgical complications were reported in 8% of patients in the 1-cm group and 15% in the 3-cm group.
The investigators concluded: “Our findings suggest that a 1 cm excision margin is inadequate for cutaneous melanoma with Breslow thickness greater than 2 mm on the trunk and limbs. Current guidelines advise a 2 cm margin for melanomas greater than 2 mm in thickness but only a 1 cm margin for thinner melanomas. The adequacy of a 1 cm margin for thinner melanomas with poor prognostic features should be addressed in future randomized studies.”
The study was funded by Cancer Research UK, North Thames National Health Service Executive, Northern and Yorkshire National Health Service Executive, British United Provident Association Foundation, British Association of Plastic Surgeons, the Meirion Thomas Cancer Research Fund, and the National Institute for Health and Research Biomedical Research Centre at The Royal Marsden NHS Foundation Trust.
Andrew J. Hayes, FRCS, of The Royal Marsden NHS Foundation Trust, is the corresponding author of The Lancet Oncology article.
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