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Evidence summaries

Excision Margin for Malignant Melanoma

A wide excision margin (3-5 cm) of melanoma may not be better for overall survival than a narrower margin (1-2 cm). There is insufficient evidence on optimal excision margins for different Breslow thickness of cutaneous melanoma. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 5 studies with a total of 3 297 subjects with cutaneous invasive melanoma (not melanoma-in-situ where the melanoma cells are confined to the epidermis). Narrow margin definition ranged from 1 to 2 cm; wide margins ranged from 3 to 5 cm. Median follow-up ranged from 5 to 16 years. The summary estimate for overall survival favoured wide excision by a small degree (HR 1.04, 95% CI 0.95 to 1.15), but the result was not statistically significantly different. The summary estimate for recurrence free survival favoured wide excision (HR 1.13, 95% CI 0.99 to 1.28, p=0.06) but again the result did not reach statistical significance. There were insufficient data to perform a subgroup analysis of overall survival stratified by Breslow thickness.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and inadequate intention-to-treat adherence), and by inconsistency (heterogeneity in results in different populations).

    References

    • Sladden MJ, Balch C, Barzilai DA, Berg D, Freiman A, Handiside T, Hollis S, Lens MB, Thompson JF. Surgical excision margins for primary cutaneous melanoma. Cochrane Database Syst Rev 2009;(4):CD004835. [PubMed]

Primary/Secondary Keywords