Abstract
In this retrospective review of 100 patients with primary invasive acral melanoma, we examined whether narrow-margin excision is warranted for acral melanoma. Patients treated with surgical margins recommended by the National Comprehensive Cancer Network (R-group) were compared to those treated with narrow margins (N-group). A total of 65 patients underwent narrow-margin excision. Positive margin status or local recurrence rarely occurred regardless of the excision margins, whereas fatal events frequently occurred, particularly among the patients with T4 melanoma. The mortality rates of N- and R-group with T1–3 melanomas were similar (1.36 and 1.28 per 100 person-years, respectively). However, patients with T4 melanoma treated with narrow-margin excision had a higher mortality rate (11.44 vs. 5.03 per 100 person-years). Kaplan–Meier analyses showed a worse prognosis in the N-group (p = 0.045) but this group had thicker Breslow thickness (4.21 mm vs. 2.03 mm, p = 0.0013). A multivariate analysis showed that Breslow thickness was an independent risk factor, but surgical margin was not a risk factor for melanoma-specific survival or disease-free survival. In conclusion, although we could not find a difference between the narrow-margin excision and recommended-margin excision in this study, we suggest following current recommendations of guidelines. Our study warrants the prospective collection of data on acral melanoma to better define the prognosis of this infrequent type of melanoma.
Highlights
Malignant melanoma is an aggressive tumor that mostly arises on the skin
All melanomas were histopathologically acral lentiginous melanomas with the epidermal component extending more than three rate ridges lateral to the dermal component
Among patients in the N-group, we found 14 patients whose acral melanomas were resected with sufficient margins from nodules (Figure 2A,B shows an example of such cases)
Summary
Malignant melanoma is an aggressive tumor that mostly arises on the skin. The incidence of this disease is increasing worldwide [1,2]. Extensive excision inevitably involves unnecessary removal of normal tissue, causing large skin defects. In such cases, skin grafting or skin flaps, rather than simple suturing, may be needed to close the defects. A large randomized controlled study (n = 936) found no significant differences in either overall survival or recurrence-free survival between patients with thick melanoma (>4 mm) who underwent resections with 2-cm or 4-cm margins [12].
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