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Size of Excision Margins and Survival Outcomes in Cutaneous Melanomas

By: Joseph Fanelli
Posted: Thursday, September 19, 2019

According to findings from a nearly 20-year follow-up trial presented in The Lancet, there is reportedly no difference in survival outcomes when comparing 2-cm and 4-cm surgical excision margins for localized cutaneous melanomas thicker than 2 cm. These results, concluded Deborah Utjés, MD, of the Karolinska Institutet, Stockholm, and colleagues, reinforce the current clinical practice of using 2-cm excision margins and confirm previous trial data after a median follow-up of 6.7 years.

“Additionally, analysis stratified by prognostic factors did not reveal any association between survival and narrow versus wide excision margins in these specific subgroups,” the authors observed. “As expected, we found that established prognostic factors, such as male sex and presence of ulceration, were independent predictors of a shorter melanoma-specific survival.”

In this open-label, multicenter randomized, controlled trial, the investigators enrolled 936 clinically staged patients from hospitals across Sweden, Denmark, Estonia, and Norway; they all had localized cutaneous melanomas thicker than 2 mm and a primary site on the trunk or upper and lower extremities. Patients were aged 75 or younger and had either a 2-cm excision margin (471 patients) or 4-cm excision margin (465 patients).

After a median overall follow-up of 19.6 years, 621 of the patients had died, including 304 (49%) from the 2-cm group and 317 (51%) from the 4-cm group. The investigators attributed 397 of the deaths within both cohorts to cutaneous melanoma (192 and 205, respectively). These findings, the authors noted, are in line with the results from a previous trial report, which found no difference in melanoma-specific or overall survival after a median follow-up of 6.7 years.

Disclosure: The study authors reported no conflicts of interest.



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