Recurrence rate and survival implications of surgical margins in patients with acral melanoma. Is a wide margin necessary?

Abstract

Appropriate size of resection margins in acral melanoma is not clearly established. To investigate whether narrow-margin excision is appropriate for thick acral melanoma. Three-hundred and six patients with acral melanoma were examined. Factors associated with recurrence and survival were analyzed according to surgical margin size (1 to 2 cm and > 2 cm). Out of 306 patients, 183 were women (59.8%). Median Breslow thickness was 6 mm; 224 cases (73.2%) were ulcerated, 154 patients (50.3%) had clinical stage III disease, while 137 were at stage II (44.8%) and 15 at stage IV (4.9%). All cases had negative margins, with a median of 31.5 mm. A Breslow thickness of 7 mm (p = 0.001) and clinical stage III (p = 0.031) were associated with recurrence; the factors associated with survival were Breslow index (p = 0.047), ulceration (p = 0.003), advanced clinical stage (p < 0.001), and use of adjuvant therapy (p = 0.003). A resection margin of 1 to 2 cm did not affect tumor recurrence or survival in patients with acral melanoma.