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Annals of Surgical Oncology

, Volume 23, Issue 4, pp 1082–1089 | Cite as

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

  • Alastair D. MacKenzie Ross
  • Lauren E. Haydu
  • Michael J. Quinn
  • Robyn P. M. Saw
  • Kerwin F. Shannon
  • Andrew J. Spillane
  • Jonathan R. Stretch
  • Richard A. Scolyer
  • John F. Thompson
Melanomas

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.

Keywords

Melanoma Local Recurrence Primary Melanoma Breslow Thickness Excision Margin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

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.

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Alastair D. MacKenzie Ross
    • 1
    • 2
  • Lauren E. Haydu
    • 1
    • 3
  • Michael J. Quinn
    • 1
    • 3
    • 4
  • Robyn P. M. Saw
    • 1
    • 3
    • 4
  • Kerwin F. Shannon
    • 1
    • 3
    • 4
  • Andrew J. Spillane
    • 1
    • 3
  • Jonathan R. Stretch
    • 1
    • 3
    • 4
  • Richard A. Scolyer
    • 1
    • 3
    • 5
  • John F. Thompson
    • 1
    • 3
    • 4
  1. 1.Melanoma Institute AustraliaNorth SydneyAustralia
  2. 2.Department of Plastic SurgeryGuy’s and St Thomas’ NHS Foundation TrustLondonUK
  3. 3.Sydney Medical SchoolThe University of SydneySydneyAustralia
  4. 4.Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalCamperdownAustralia
  5. 5.Department of Tissue Pathology and Diagnostic OncologyRoyal Prince Alfred HospitalCamperdownAustralia

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