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  • 5-mm margins may be...

5-mm margins may be adequate for T1a melanoma excision near critical structures

Written By : Dr. Shravani Dali |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-04-17T19:45:55+05:30  |  Updated On 17 April 2023 7:48 PM IST
5-mm margins may be adequate for T1a melanoma excision near critical structures
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Researchers have found in a new research that 5-mm margins may be adequate for T1a melanoma excision near critical structures and may not be associated with an increased risk of local recurrence.

The study published in the JAMA Dermatology

Melanoma guidelines recommend surgical excision with 10-mm margins for T1 melanoma. However, this procedure may be problematic at sites close to critical structures such as the scalp, face, external genitalia, acral, periumbilical, and perineal areas.

A study was done to compare outcomes of wide (10-mm margins) vs narrow (5-mm margins) excision in patients with T1a melanoma near critical structures.

This cohort study was a retrospective comparison of 1341 consecutive patients aged 18 years or older from the National Cancer Institute of Milan, Italy, diagnosed between 2001 and 2020 with T1a cutaneous melanoma close to critical structures who accepted wide excision vs narrow excision. Local recurrence and melanoma-specific mortality (MSM) rates with 5-mm vs 10-mm excision margins.

The primary aim of the study was to ascertain whether a narrower (5-mm) vs wider (10-mm) excision margin was associated with local recurrence and MSM. The secondary aim was to compare the need for reconstructive surgery in the groups defined by excision margin width. Between April 28 and August 7, 2022, associations were assessed by weighted Cox and Fine-Gray univariable and multivariable models.

Results

A total of 1179 patients met the inclusion criteria

Six hundred twenty-six patients (53.1%) received a wide excision (434 [69.3%] with linear repair and 192 [30.7%] with flap or graft reconstruction) and 553 (46.9%) received a narrow excision

The weighted 10-year MSM was 1.8% in the wide group and 4.2% in the narrow group; the weighted 10-year local recurrence rate was 5.7% in the wide group and 6.7% (95% CI, 4.7%-9.5%) in the narrow group.

Breslow thickness greater than 0.4 mm and mitotic rate greater than 1/mm2 were associated with worse MSM.

Multivariable analysis showed that acral lentiginous melanoma, lentigo maligna melanoma, and increasing Breslow thickness were associated with a higher incidence of local recurrence.

The study’s findings suggest that local excision with 5-mm margins for T1a melanoma may not be associated with an increased risk of local recurrence. Breslow thickness greater than 0.4 mm, mitotic rate greater than 1/mm2, and acral lentiginous melanoma and lentigo maligna melanoma subtypes were associated with a higher risk of recurrence. These findings may be useful for future melanoma treatment guidelines.

Reference:

Maurichi A, Barretta F, Patuzzo R, et al. Association of Excision Margin Size With Local Recurrence and Survival in Patients With T1a Melanoma at Critical Structures. JAMA Dermatol. Published online April 12, 2023. doi:10.1001/jamadermatol.2023.0620


JAMA DermatologyLocalRecurrenceSurvivalPatientT1a melanomaCritical Structures
Source : JAMA Dermatology
Dr. Shravani Dali
Dr. Shravani Dali

    Dr. Shravani Dali has completed her BDS from Pravara institute of medical sciences, loni. Following which she extensively worked in the healthcare sector for 2+ years. She has been actively involved in writing blogs in field of health and wellness. Currently she is pursuing her Masters of public health-health administration from Tata institute of social sciences. She can be contacted at editorial@medicaldialogues.in.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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