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The Association Between Excision Margins and Local Recurrence in 11,290 Thin (T1) Primary Cutaneous Melanomas: A Case–Control Study

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

At presentation, most primary cutaneous melanomas are “thin” (Breslow thickness ≤1 mm, designated T1 in the American Joint Committee on Cancer staging system) and local recurrence (LR) is rare. Most current management guidelines recommend 1 cm surgical excision margins for T1 melanomas, but evidence to support this recommendation is sparse. We sought to identify clinical and pathologic factors associated with LR in patients with T1 melanomas that might guide primary tumor management.

Methods

From a large, prospectively collected, single-institution database, patients with primary cutaneous melanomas ≤1 mm thick diagnosed between 1970 and 2011 who developed LR were identified and matched with controls. Clinical and pathologic parameters were analyzed for their association with LR.

Results

From 11,290 primary melanomas ≤1 mm thick, 176 (1.56 %) cases with LR were identified and 176 controls (without LR) were selected. LR occurred after a median time of 37 months (range 3–306 months) and was associated with narrower excision margins (hazard ratio = 0.95, 95 % confidence interval 0.92–0.98, p = 0.001), desmoplastic, acral, and lentigo maligna melanoma subtypes (p = 0.008), and melanomas composed predominantly of spindle cells (p = 0.005). However, Breslow thickness, Clark level, ulceration, mitotic rate, regression, and lymphovascular invasion were not.

Conclusions

LR was associated with <8 mm histologic excision margins (corresponding to <1 cm margins in vivo) and desmoplastic, acral, and lentigo maligna melanoma subtypes. This study provides evidence that a ≥1 cm clinical excision margin for thin (T1) primary melanomas reduces the risk of LR.

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Acknowledgment

The authors gratefully acknowledge funding support from the National Health and Medical Research Council, Cancer Institute New South Wales, The Melanoma Foundation of the University of Sydney, and MIA. A.D.M.R. was the recipient of a Poche Fellowship at MIA.

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Melanoma Institute Australia, North Sydney, NSW, Australia

    Alastair D. MacKenzie Ross MD, FRCS (Plast), Lauren E. Haydu BSCHE, MIPH, Michael J. Quinn MBBS, FRACS, Robyn P. M. Saw MB, MS, FRACS, Kerwin F. Shannon MBBS, FRACS, Andrew J. Spillane MD, FRACS, Jonathan R. Stretch MBBS, DPhil(Oxon), FRACS, Richard A. Scolyer MD, FRCPA, FRCPath & John F. Thompson MD, FRACS, FACS

  2. Department of Plastic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Alastair D. MacKenzie Ross MD, FRCS (Plast)

  3. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Lauren E. Haydu BSCHE, MIPH, Michael J. Quinn MBBS, FRACS, Robyn P. M. Saw MB, MS, FRACS, Kerwin F. Shannon MBBS, FRACS, Andrew J. Spillane MD, FRACS, Jonathan R. Stretch MBBS, DPhil(Oxon), FRACS, Richard A. Scolyer MD, FRCPA, FRCPath & John F. Thompson MD, FRACS, FACS

  4. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Michael J. Quinn MBBS, FRACS, Robyn P. M. Saw MB, MS, FRACS, Kerwin F. Shannon MBBS, FRACS, Jonathan R. Stretch MBBS, DPhil(Oxon), FRACS & John F. Thompson MD, FRACS, FACS

  5. Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Richard A. Scolyer MD, FRCPA, FRCPath

Authors
  1. Alastair D. MacKenzie Ross MD, FRCS (Plast)
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  2. Lauren E. Haydu BSCHE, MIPH
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  3. Michael J. Quinn MBBS, FRACS
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  4. Robyn P. M. Saw MB, MS, FRACS
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  5. Kerwin F. Shannon MBBS, FRACS
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  6. Andrew J. Spillane MD, FRACS
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  7. Jonathan R. Stretch MBBS, DPhil(Oxon), FRACS
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  8. Richard A. Scolyer MD, FRCPA, FRCPath
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  9. John F. Thompson MD, FRACS, FACS
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Corresponding author

Correspondence to John F. Thompson MD, FRACS, FACS.

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MacKenzie Ross, A.D., Haydu, L.E., Quinn, M.J. et al. The Association Between Excision Margins and Local Recurrence in 11,290 Thin (T1) Primary Cutaneous Melanomas: A Case–Control Study. Ann Surg Oncol 23, 1082–1089 (2016). https://doi.org/10.1245/s10434-015-4942-0

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  • DOI: https://doi.org/10.1245/s10434-015-4942-0

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