Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1983 Nov;198(5):634–641. doi: 10.1097/00000658-198311000-00013

The extent of primary melanoma excision. A re-evaluation--how wide is wide?

D R Aitken, K Clausen, J P Klein, A G James
PMCID: PMC1353137  PMID: 6639164

Abstract

A retrospective review of 118 clinical Stage I melanoma patients, including the re-examination of histologic slides in 57 cases, was performed to define factors important to survival. The majority (76.7%) had excision margins of 30 mm or less (range = 6-85 mm, mean--29.3 mm). The adjusted 5-year survival was 77.3%. Local recurrences within 5 cm of the primary closure scar developed in 3.4%. The recurrences occurred in patients with satellitosis (1), unrecognized subclinical Stage II disease (1), or as the first evidence of disseminated Stage III disease (2). Margins less than 20 mm were associated with an increased risk of dying if the tumor diameter was more than 10 mm (p = 0.0105) or if the depth of invasion was more than 2.0 mm (p = 0.0491). Increasing the margin to 25 mm improved survival. However, no further protection was evident for margins over 30 mm. For smaller and shallower lesions, no optimal margin could be identified. It appears that a 30 mm margin is adequate for large and deep clinical Stage I melanomas, and mortality and local recurrences are due to factors other than the extent of excision.

Full text

PDF
641

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bagley F. H., Cady B., Lee A., Legg M. A. Changes in clinical presentation and management of malignant melanoma. Cancer. 1981 May 1;47(9):2126–2134. doi: 10.1002/1097-0142(19810501)47:9<2126::aid-cncr2820470904>3.0.co;2-c. [DOI] [PubMed] [Google Scholar]
  2. Balch C. M., Murad T. M., Soong S. J., Ingalls A. L., Halpern N. B., Maddox W. A. A multifactorial analysis of melanoma: prognostic histopathological features comparing Clark's and Breslow's staging methods. Ann Surg. 1978 Dec;188(6):732–742. doi: 10.1097/00000658-197812000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Balch C. M., Murad T. M., Soong S. J., Ingalls A. L., Richards P. C., Maddox W. A. Tumor thickness as a guide to surgical management of clinical stage I melanoma patients. Cancer. 1979 Mar;43(3):883–888. doi: 10.1002/1097-0142(197903)43:3<883::aid-cncr2820430316>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  4. Balch C. M., Soong S. J., Murad T. M., Ingalls A. L., Maddox W. A. A multifactorial analysis of melanoma. II. Prognostic factors in patients with stage I (localized) melanoma. Surgery. 1979 Aug;86(2):343–351. [PubMed] [Google Scholar]
  5. Barclay T. L., Crockett D. J., Eastwood D. S., Eastwood J., Giles G. R. Assessment of prognosis in cutaneous malignant melanoma. Br J Surg. 1977 Jan;64(1):54–58. doi: 10.1002/bjs.1800640114. [DOI] [PubMed] [Google Scholar]
  6. Breslow A., Macht S. D. Optimal size of resection margin for thin cutaneous melanoma. Surg Gynecol Obstet. 1977 Nov;145(5):691–692. [PubMed] [Google Scholar]
  7. Breslow A. Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Ann Surg. 1970 Nov;172(5):902–908. doi: 10.1097/00000658-197011000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cady B., Legg M. A., Redfern A. B. Contemporary treatment of malignant melanoma. Am J Surg. 1975 Apr;129(4):472–482. doi: 10.1016/0002-9610(75)90195-6. [DOI] [PubMed] [Google Scholar]
  9. Clark W. H., Jr, Ainsworth A. M., Bernardino E. A., Yang C. H., Mihm C. M., Jr, Reed R. J. The developmental biology of primary human malignant melanomas. Semin Oncol. 1975 Jun;2(2):83–103. [PubMed] [Google Scholar]
  10. Clark W. H., Jr, From L., Bernardino E. A., Mihm M. C. The histogenesis and biologic behavior of primary human malignant melanomas of the skin. Cancer Res. 1969 Mar;29(3):705–727. [PubMed] [Google Scholar]
  11. Cochran A. J. Studies of the melanocytes of the epidermis adjacent to tumors. J Invest Dermatol. 1971 Jul;57(1):38–43. doi: 10.1111/1523-1747.ep12292060. [DOI] [PubMed] [Google Scholar]
  12. Davis N. C. Cutaneous melanoma. The Queensland experience. Curr Probl Surg. 1976 May;13(5):1–63. doi: 10.1016/s0011-3840(76)80013-5. [DOI] [PubMed] [Google Scholar]
  13. Day C. L., Jr, Lew R. A., Mihm M. C., Jr, Sober A. J., Harris M. N., Kopf A. W., Fitzpatrick T. B., Harrist T. J., Golomb F. M., Postel A. A multivariate analysis of prognostic factors for melanoma patients with lesions greater than or equal to 3.65 mm in thickness. The importance of revealing alternative Cox models. Ann Surg. 1982 Jan;195(1):44–49. doi: 10.1097/00000658-198201001-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Day C. L., Jr, Mihm M. C., Jr, Lew R. A., Harris M. N., Kopf A. W., Fitzpatrick T. B., Harrist T. J., Golomb F. M., Postel A., Hennessey P. Prognostic factors for patients with clinical stage I melanoma of intermediate thickness (1.51 - 3.39 mm). A conceptual model for tumor growth and metastasis. Ann Surg. 1982 Jan;195(1):35–43. doi: 10.1097/00000658-198201001-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Day C. L., Jr, Mihm M. C., Jr, Lew R. A., Kopf A. W., Sober A. J., Fitzpatrick T. B. Cutaneous malignant melanoma: prognostic guidelines for physicians and patients. CA Cancer J Clin. 1982 Mar-Apr;32(2):113–122. doi: 10.3322/canjclin.32.2.113. [DOI] [PubMed] [Google Scholar]
  16. Day C. L., Jr, Mihm M. C., Jr, Sober A. J., Fitzpatrick T. B., Malt R. A. Narrower margins for clinical stage I malignant melanoma. N Engl J Med. 1982 Feb 25;306(8):479–482. doi: 10.1056/NEJM198202253060810. [DOI] [PubMed] [Google Scholar]
  17. Drzewiecki K. T., Andersen P. K. Survival with malignant melanoma: a regression analysis of prognostic factors. Cancer. 1982 Jun 1;49(11):2414–2419. doi: 10.1002/1097-0142(19820601)49:11<2414::aid-cncr2820491132>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  18. Eldh J., Boeryd B., Peterson L. E. Prognostic factors in cutaneous malignant melanoma in stage I. A clinical, morphological and multivariate analysis. Scand J Plast Reconstr Surg. 1978;12(3):243–255. doi: 10.3109/02844317809013000. [DOI] [PubMed] [Google Scholar]
  19. Elias E. G., Didolkar M. S., Goel I. P., Formeister J. F., Valenzuela L. A., Pickren J. L., Moore R. H. A clinicopathologic study of prognostic factors in cutaneous malignant melanoma. Surg Gynecol Obstet. 1977 Mar;144(3):327–334. [PubMed] [Google Scholar]
  20. Everall J. D., Dowd P. M. Diagnosis, prognosis, and treatment of melanoma. Lancet. 1977 Aug 6;2(8032):286–289. doi: 10.1016/s0140-6736(77)90965-5. [DOI] [PubMed] [Google Scholar]
  21. Fee H. J., Robinson D. S., Sample W. F., Graham L. S., Holmes E. C., Morton D. L. The determination of lymph shed by colloidal gold scanning in patients with malignant melanoma: a preliminary study. Surgery. 1978 Nov;84(5):626–632. [PubMed] [Google Scholar]
  22. Fidler I. J., Gersten D. M., Hart I. R. The biology of cancer invasion and metastasis. Adv Cancer Res. 1978;28:149–250. doi: 10.1016/s0065-230x(08)60648-x. [DOI] [PubMed] [Google Scholar]
  23. Goldman L. I. The surgical therapy of malignant melanomas. Semin Oncol. 1975 Jun;2(2):175–178. [PubMed] [Google Scholar]
  24. Goldman L. I. The treatment of malignant melanoma of the skin. Surg Gynecol Obstet. 1978 May;146(5):779–782. [PubMed] [Google Scholar]
  25. Gupta T. K. Results of treatment of 269 patients with primary cutaneous melanoma: a five-year prospective study. Ann Surg. 1977 Aug;186(2):201–209. doi: 10.1097/00000658-197708000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Hansen M. G., McCarten A. B. Tumor thickness and lymphocytic infiltration in malignant melanoma of the head and neck. Am J Surg. 1974 Oct;128(4):557–561. doi: 10.1016/0002-9610(74)90275-x. [DOI] [PubMed] [Google Scholar]
  27. LANE N., LATTES R., MALM J. Clinicopathological correlations in a series of 117 malignant melanomas of the skin of adults. Cancer. 1958 Sep-Oct;11(5):1025–1043. doi: 10.1002/1097-0142(195809/10)11:5<1025::aid-cncr2820110525>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]
  28. MEHNERT J. H., HEARD J. L. STAGING OF MALIGNANT MELANOMAS BY DEPTH OF INVASION; A PROPOSED INDEX TO PROGNOSIS. Am J Surg. 1965 Aug;110:168–176. doi: 10.1016/0002-9610(65)90008-5. [DOI] [PubMed] [Google Scholar]
  29. Macht S. D. Treatment of cutaneous melanoma. Surg Gynecol Obstet. 1980 Aug;151(2):251–252. [PubMed] [Google Scholar]
  30. McNeer G., Cantin J. Local failure in the treatment of melanoma. The Janeway lecture, 1966. Am J Roentgenol Radium Ther Nucl Med. 1967 Apr;99(4):791–808. doi: 10.2214/ajr.99.4.791. [DOI] [PubMed] [Google Scholar]
  31. Olsen G. The malignant melanoma of the skin. New theories based on a study of 500 cases. Acta Chir Scand Suppl. 1966;365:1–222. [PubMed] [Google Scholar]
  32. PETERSEN N. C., BODENHAM D. C., LLOYD O. C. Malignant melanomas of the skin. A study of the origin, development, aetiology, spread, treatment, and prognosis. Br J Plast Surg. 1962 Apr;15:97–116. doi: 10.1016/s0007-1226(62)80015-0. [DOI] [PubMed] [Google Scholar]
  33. Pitt T. T. Aspects of surgical treatment for malignant melanoma: the place of biopsy and wide excision. Aust N Z J Surg. 1977 Dec;47(6):757–766. doi: 10.1111/j.1445-2197.1977.tb06619.x. [DOI] [PubMed] [Google Scholar]
  34. Rees W. V., Robinson D. S., Holmes E. C., Morton D. L. Altered lymphatic drainage following lymphadenectomy. Cancer. 1980 Jun 15;45(12):3045–3049. doi: 10.1002/1097-0142(19800615)45:12<3045::aid-cncr2820451228>3.0.co;2-y. [DOI] [PubMed] [Google Scholar]
  35. STEHLIN J. S., Jr, CLARK R. L. MELANOMA OF THE EXTREMITIES; EXPERIENCES WITH CONVENTIONAL TREATMENT AND PERFUSION IN 339 CASES. Am J Surg. 1965 Sep;110:366–383. doi: 10.1016/0002-9610(65)90076-0. [DOI] [PubMed] [Google Scholar]
  36. Seigler H. F., Fetter B. F. Current management of melanoma. Ann Surg. 1977 Jul;186(1):1–12. doi: 10.1097/00000658-197707000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Stage I melanoma of the skin: the problem of resection margins. W.H.O. Collaborating Centres for Evaluation of Methods of Diagnosis and Treatment of Melanoma. Eur J Cancer. 1980 Aug;16(8):1079–1085. [PubMed] [Google Scholar]
  38. Stehlin J. S., Jr Treatment of the primary lesion in melanoma. Surg Gynecol Obstet. 1981 Apr;152(4):499–500. [PubMed] [Google Scholar]
  39. Sugarbaker E. V., McBride C. M. Melanoma of the trunk: the results of surgical excision and anatomic guidelines for predicting nodal metastasis. Surgery. 1976 Jul;80(1):22–30. [PubMed] [Google Scholar]
  40. Wanebo H. J., Woodruff J., Fortner J. G. Malignant melanoma of the extremities: a clinicopathologic study using levels of invasion (microstage). Cancer. 1975 Mar;35(3):666–676. doi: 10.1002/1097-0142(197503)35:3<666::aid-cncr2820350320>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
  41. Wong C. K. A study of melanocytes in the normal skin surrounding malignant melanomata. Dermatologica. 1970;141(3):215–225. doi: 10.1159/000252469. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES