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Is a Wider Margin (2 cm vs. 1 cm) for a 1.01–2.0 mm Melanoma Necessary?

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

ABSTRACT

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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Disclosures

Consulting fees and research support has been provided to Jonathan S. Zager by Amgen, Castle Biosciences and Provectus. Grant support and medical advisory board for Delcath Systems.

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Authors and Affiliations

  1. Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA

    Matthew P. Doepker MD, Kevin W. Nethers MS, Jennifer N. Harb MD, Matthew A. Applebaum MS, Ricardo J. Gonzalez MD, Amod A. Sarnaik MD, Vernon K. Sondak MD & Jonathan S. Zager MD, FACS

  2. Department of Biostatistics, Moffitt Cancer Center, Tampa, FL, USA

    Zachary J. Thompson PhD & Kate J. Fisher MA

  3. Department of Surgical Oncology, University of California, Irvine Medical Center, Orange, CA, USA

    Maki Yamamoto MD

  4. Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL, USA

    Jane L. Messina MD

Authors
  1. Matthew P. Doepker MD
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  2. Zachary J. Thompson PhD
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  3. Kate J. Fisher MA
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  4. Maki Yamamoto MD
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  5. Kevin W. Nethers MS
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  6. Jennifer N. Harb MD
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  7. Matthew A. Applebaum MS
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  8. Ricardo J. Gonzalez MD
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  9. Amod A. Sarnaik MD
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  10. Jane L. Messina MD
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  11. Vernon K. Sondak MD
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  12. Jonathan S. Zager MD, FACS
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Corresponding author

Correspondence to Jonathan S. Zager MD, FACS.

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Doepker, M.P., Thompson, Z.J., Fisher, K.J. et al. Is a Wider Margin (2 cm vs. 1 cm) for a 1.01–2.0 mm Melanoma Necessary?. Ann Surg Oncol 23, 2336–2342 (2016). https://doi.org/10.1245/s10434-016-5167-6

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  • DOI: https://doi.org/10.1245/s10434-016-5167-6

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