2-cm versus 4-cm surgical excision margin for thick (>2 mm) primary malignant melanoma: long-term follow-up of a multicenter randomized trial

Abstract

Background: Historically, wider excision margins as compared to today have been recommended for primary localized cutaneous melanoma (CM). With time less extensive surgery has become more established, although evidence to support this approach has been challenged. Consequently, surgical management guidelines vary worldwide, and excision margins differ from 1-3 cm for primary CMs with > 2 mm tumor thickness. Currently, for thick tumors the British recommendations suggest a more extensive approach (2-3 cm excision margin) whereas, Australian guidelines suggest a less extensive approach (1-2 cm excision margin). These discrepancies may reflect lack of evidence when agreeing on national and international recommendations for surgical management of primary CMs. Several randomized controlled trials (RCTs) have addressed the issue of appropriate margins for localized CM >2 mm in tumor thickness. Recently some doubts have been expressed in a RCT follow-up that a small excision margins would influence survival in a negative way. In meta-analysis studies it has also been highlighted that more evidence is needed.