Excision Margins for Primary Cutaneous Melanoma: Title and subTitle BreakUpdated Pooled Analysis of Randomized Controlled Trials FREE

Surgical treatment of melanoma is the standard of care for all primary melanomas and consists of en bloc excision of the tumor or biopsy site with a margin containing normal-appearing skin and underlying subcutaneous tissue.¹ For decades, excision margins of 5 cm or greater in all directions from the tumor border were standard in the surgical treatment of melanoma, based as much on surgical dogma as on scientific evidence. However, the necessity for wide excision was challenged more than 20 years ago, and many surgeons now excise cutaneous melanomas with increasingly narrower margins, believing that there is no reason to treat melanomas differently from any other tumor and in an effort to reduce morbidity.² Currently recommended excision margins for primary melanoma are given in Table 1.^{1 ,3 - 5}

We previously carried out a meta-analysis of 4 randomized trials⁶ and showed that there is no statistically significant difference in recurrences and disease-free and overall survival between patients treated with narrow excision margins vs patients treated with wide excision margins. Although the results from our previous meta-analysis provided further evidence that excision margins (>1 cm) have no effect on disease-free survival or overall survival in patients with melanomas less than 2 mm thick, pooled data were insufficient to address the optimal surgical management for all melanomas.

Recent publication of the United Kingdom Melanoma Study Group and the British Association of Plastic Surgeons randomized trial comparing 1- vs 3-cm excision margins for cutaneous malignant melanoma with a Breslow thickness of 2 mm or greater reopened the discussion about surgical margins in melanoma.⁷ Another large study conducted in 9 European centers examining excision margins in melanoma was also reported in 2003.⁸ The present study provides an updated meta-analysis of 5 published prospective randomized trials evaluating the effect of width of excision margins on survival of patients with melanoma and on the development of melanoma recurrences.