Does Size of Surgical Excision Margins for Thick Localized Cutaneous Melanoma Affect Survival Outcomes?


Key Points

  • There were no significant differences between 2-cm and 4-cm excision groups in overall or melanoma-specific survival at a median of 19.6 years.
  • For melanoma-specific death, absolute rates per 100 person-years were 3.9 vs 4.1.

In a nearly 20-year follow-up of a Scandinavian trial reported in The Lancet, Utjés et al found no difference in survival outcomes with 2-cm vs 4-cm surgical excision margins for primary localized cutaneous melanoma with a thickness > 2 mm. The previous report from the trial showed no difference in melanoma-specific or overall survival between the two approaches after a median follow-up of 6.7 years.

The trial included 936 patients with primary disease on the trunk or upper or lower extremities from 53 sites in Sweden, Denmark, Estonia, and Norway. They had a median age of 59 to 60 years at baseline. 

Patients were randomly assigned between January 1992 and May 2004 to a 2-cm excision margin (n = 471) or a 4-cm excision margin (n = 465). The co-primary outcomes in the current extended follow-up were overall survival and melanoma-specific survival in the intent-to-treat populations.

Overall and Melanoma-Specific Survival

At a median follow-up of 19.6 years, there were 621 deaths, including 304 (49%) in the 2-cm group and 317 (51%) in the 4-cm group (unadjusted hazard ratio [HR] = 0.98, P = .75). For overall mortality, absolute rates per 100 person-years were 6.1 vs 6.3.

A total of 397 deaths were attributed to melanoma, consisting of 192 (48%) in the 2-cm excision margin group and 205 (52%) in the 4-cm excision margin group (unadjusted HR = 0.95, P = .61). For melanoma-specific death, absolute rates per 100 person-years were 3.9 vs 4.1. In multivariate analysis, adjustment for prognostic factors did not change the hazard ratios for the 2-cm excision margin group vs the 4-cm excision margin group.

For overall survival, probabilities of survival for the 2-cm vs 4-cm groups were 65% vs 64% at 5 years, 50% vs 51% at 10 years, 40% vs 40% at 15 years, 35% vs 33% at 20 years, and 25% vs 26% at 25 years.

The investigators concluded, “A 2-cm excision margin was safe for patients with thick (> 2 mm) localized cutaneous melanoma at a [median] follow-up of 19.6 years. These findings support the use of 2-cm excision margins in current clinical practice.”

Peter Gillgren, MD, of Karolinska Institutet, Stockholm, is the corresponding author for The Lancet article.

Disclosure: The study was funded by The Swedish Cancer Society, Stockholm Cancer Society, Swedish Society for Medical Research, Radiumhemmet Research funds, Stockholm County Council, and Wallström funds. For full disclosures of the study authors, visit

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