Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1 to 4 mm). Results of a multi-institutional randomized surgical trial.

@article{Balch1993EfficacyO2,
  title={Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1 to 4 mm). Results of a multi-institutional randomized surgical trial.},
  author={Charles M. Balch and Marshall Urist and Constantine P. Karakousis and T. J. Smith and Walley J Temple and K. T. Drzewiecki and William R. Jewell and Alfred A. Bartolucci and Martin C. Jr. Mihm and Raymond L. Barnhill},
  journal={Annals of surgery},
  year={1993},
  volume={218 3},
  pages={
          262-7; discussion 267-9
        }
}
BACKGROUND A prospective, multi-institutional, randomized surgical trial involving 486 localized melanoma patients was conducted to determine whether excision margins for intermediate-thickness melanomas (1.0 to 4.0 mm) could be safely reduced from the standard 4-cm radius. METHODS Patients with 1- to 4-mm-thick melanomas on the trunk or proximal extremities were randomly assigned to receive either a 2- or 4-cm surgical margin. RESULTS The median follow-up time was 6 years. The local… 
View on PubMed
ncbi.nlm.nih.gov
404 Citations
Highly Influential Citations
7
Background Citations
37
Methods Citations
15
Results Citations
6

404 Citations

Citation Type

Citation Type

Long-term results of a prospective surgical trial comparing 2 cm vs. 4 cm excision margins for 740 patients with 1-4 mm melanomas.
TLDR
For this group of melanoma patients, a local recurrence is associated with a high mortality rate, a 2-cm margin of excision is safe and ulceration of the primary melanoma is the most significant prognostic factor heralding an increased risk for a local Recurrence.
Long-Term Results of a Prospective Surgical Trial Comparing 2 cm vs. 4 cm Excision Margins for 740 Patients With 1–4 mm Melanomas
TLDR
For this group of melanoma patients, a local recurrence is associated with a high mortality rate, a 2-cm margin of excision is safe and ulceration of the primary melanoma is the most significant prognostic factor heralding an increased risk for aLocal recurrence.
Surgical margins in cutaneous melanoma (2 cm versus 5 cm for lesions measuring less than 2.1‐mm thick)
TLDR
This analysis supports the conclusion of Khayat et al. that excision margins 2 cm are unnecessary for the majority of melanomas 2 mm in thickness, and there is insufficient evidence from randomized trials to determine which margins are acceptable in 2– 4 mm thick melanomas, although 2 cm margins are believed to be appropriate.
2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: long-term follow-up of a multicentre, randomised trial
One-cm Versus 2-cm Excision Margins for Patients With Intermediate Thickness Melanoma: A Matched-Pair Analysis
TLDR
A 1-cm excision margin may be sufficient in melanomas of 1.1 to 2.0 mm in Breslow thickness based on these findings of low recurrence, and with thicker tumors, this recommendation cannot be given due to inherent study limitations.
Surgical margins and prognostic factors in patients with thick (>4 mm) primary melanoma
TLDR
Because nodal status is a significant prognostic factor in these patients, staging by sentinel node biopsy should be considered in patients with thick melanomas and clinically negative nodal basins to allow proper entry and stratification in adjuvant therapy trials.
1 Versus 2-cm Excision Margins for pT2-pT4 Primary Cutaneous Melanoma (MelMarT): A Feasibility Study
TLDR
A pilot study comparing a 1 versus 2-cm surgical margin for patients with primary cutaneous melanoma, demonstrating the feasibility of a large international RCT to provide a definitive answer to the optimal excision margin.
The Bayesian Multiple Logistic Random Effects Model for Analysis of Clinical Trial Data
TLDR
A prospective, multi-institutional and randomized surgical trial involving 724 early stage melanoma patients was conducted to determine whether excision margins for intermediate-thickness melanomas could be safely reduced from the standard 4-cm radius, and the overall conclusion was that the narrower margins significantly reduced the need for skin grafting and shortened the hospital stay.
Resection margins in primary cutaneous melanoma.
I disagree with the conclusion reached by Piepkorn and Barnhill in a recentArchivesarticle 1 that "the choice of a resection margin [for melanoma] materially more than 1 cm has no basis in…
Margin of resection in the management of primary melanoma
TLDR
The adoption of the narrower surgical margins suggested above should reduce the morbidity caused by the radical margins of the past without compromising local control of the disease.
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 14 REFERENCES
Thin stage I primary cutaneous malignant melanoma. Comparison of excision with margins of 1 or 3 cm.
TLDR
The absence ofLocal recurrence in the group of patients with a primary melanoma thinner than 1 mm and the very low rate of local recurrences indicate that narrow excision is a safe and effective procedure for such patients.
Tumor thickness as a guide to surgical management of clinical stage I melanoma patients
TLDR
An analysis of failure to control locally recurrent or metastatic melanoma was used to substantiate the value of thickness as a guide to surgical management and the rationale of elective RND isImproved survival in patients with intermediate thickness lesions while it is justifiable as a staging procedure for lesions exceeding 4.0 mm thickness.
Conservative surgical management of superficially invasive cutaneous melanoma
TLDR
Melanomas that are not deeply invasive do not require wide excision and skin grafting for local control, but occasionally these thin lesions do produce systemic metastases, emphasizing the need for long‐term follow‐up of even “low‐risk” patients.
The influence of surgical margins and prognostic factors predicting the risk of local recurrence in 3445 patients with primary cutaneous melanoma
TLDR
The data demonstrate that: (1) the risk of local recurrence rises with increasing tumor thickness, presence of ulceration, and age; (2) melanomas less than 1 mm thick have a very lowLocal recurrence rate, even when excised with margins of 2 cm or less; and (3) local Recurrence is a poor prognostic sign because regional and systemic metastases subsequently develop in many patients.
Optimal Resection Margin for Cutaneous Malignant Melanoma
TLDR
Researchers studied 105 patients who had 109 primary melanomas in 1977 and related margin width of the definitive excision to the presence of satellites, to the subsequent development of local recurrence and in-transit metastases, and to survival.
Prognosis for recurrent stage I malignant melanoma.
TLDR
A multivariate analysis was performed to estimate the survival of patients after recurrence and one may use this mathematical model to predict the outcome of individual patients afterRecurrence and provide a more rationally based prognosis for them and their families.
Narrower margins for clinical stage I malignant melanoma.
TLDR
In the United States today, most cutaneous melanoma patients are diagnosed with cutaneous malignant melanoma, which is a type of skin cancer that is difficult to treat through traditional and innovative methods.
Local recurrences and their management
  • Cutaneous Melanoma. Philadelphia: JB Lippincott,
  • 1992
Cancer statistics
  • N. Dubrawsky
  • Mathematics
    CA: a cancer journal for clinicians
  • 1989
Narrowing resection margins for patients with low-risk melanoma
...
1
2
...