• DOI:10.1056/NEJMOA030681
• Corpus ID: 24357573

Excision margins in high-risk malignant melanoma.

@article{Thomas2004ExcisionMI,
  title={Excision margins in high-risk malignant melanoma.},
  author={J. Meirion Thomas and Julia A Newton-Bishop and Roger P. A’Hern and Gill Coombes and Michael Timmons and Judy Evans and Martin G. Cook and Jeffery M. Theaker and Mary E. Fallowfield and Trevor O'Neill and Włodzimierz Ruka and Judith M. Bliss},
  journal={The New England journal of medicine},
  year={2004},
  volume={350 8},
  pages={
          757-66
        }
}

• J. Thomas, J. Newton-Bishop, +9 authors J. Bliss
• Published 19 February 2004
• Medicine
• The New England journal of medicine

BACKGROUND
Controversy exists concerning the necessary margin of excision for cutaneous melanoma 2 mm or greater in thickness.

METHODS
We conducted a randomized clinical trial comparing 1-cm and 3-cm margins.

RESULTS
Of the 900 patients who were enrolled, 453 were randomly assigned to undergo surgery with a 1-cm margin of excision and 447 with a 3-cm margin of excision; the median follow-up was 60 months. A 1-cm margin of excision was associated with a significantly increased risk of locoregional recurrence. There were 168 locoregional recurrences (as first events) in the group with 1-cm margins of excision, as compared with 142 in the group with 3-cm margins (hazard ratio, 1.26; 95 percent confidence interval, 1.00 to 1.59; P=0.05). There were 128 deaths attributable to melanoma in the group with 1-cm margins, as compared with 105 in the group with 3-cm margins (hazard ratio, 1.24; 95 percent confidence interval, 0.96 to 1.61; P=0.1); overall survival was similar in the two groups (hazard ratio for death, 1.07; 95 percent confidence interval, 0.85 to 1.36; P=0.6).

CONCLUSIONS
A 1-cm margin of excision for melanoma with a poor prognosis (as defined by a tumor thickness of at least 2 mm) is associated with a significantly greater risk of regional recurrence than is a 3-cm margin, but with a similar overall survival rate.