Table 1.
Surgical excision margin recommendations for melanoma in situ in international guidelines
| Guideline group | Country | Year | Recommendation related to melanoma in situ | Level/grade of evidence |
|---|---|---|---|---|
| European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO), and the European Organization for Research and Treatment of Cancer [49] | Europe | 2020 | Margin; 5 mm | 100% consensus, adapted from other guidelines |
| Japanese Dermatological Association Guidelines [50] | Japan | 2020 | Margin; 3–5 mm | Not stated |
| Norwegian Heath Directorate guideline [51] | Norway | 2020 | Margin; 5 mm | Level 4, grade D (case series, poor quality cohort and case–control studies, expert opinion) |
| Cancer Council Australia Melanoma Guidelines Working Group [9] | Australia and New Zealand | 2019 |
Margin; 5–10 mm Melanoma in situ of non-lentigo maligna type is likely to be completely excised with 5 mm margins whereas lentigo maligna may require wider excision. Minimum clearances from all margins should be stated/assessed. Consideration should be given to further excision if necessary; positive histological margins are unacceptable |
Level 4 (case series, poor quality cohort and case–control studies) |
| Cancer Care Ontario [10] | Canada | 2019 | Margin; 5–10 mm | Not stated |
| European Society for Medical Oncology (ESMO) [52] | Europe | 2019 | Margin; 5 mm | All margins; level II (RCT), grade B (strong or moderate evidence generally recommended) |
| Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF [53] | Germany | 2019 | A complete excision with histopathological control should be performed | Consensus 88% |
| Italian Association of Medical Oncologists [54] | Italy | 2019 | Margin; 5 mm | Low |
| Regional Cancer Centre [55] | Sweden | 2019 | Margin; about 5 mm | Not stated |
| American Academy of Dermatology [8] | USA | 2019 | Margin; 5–10 mm | Lower level (not further explained) |
| National Comprehensive Cancer Network (NCCN) [7] | USA | 2019 | Margin; 5–10 mm | Level 2B (lower level evidence, NCCN consensus) |
| European CanCer Organisation (ECCO) [56] | Europe | 2018 | Margin; 5 mm | Not stated |
| Finnish Melanoma Group [57] | Finland |
2018 2012 |
2018; NS 2012; margin; 5–10 mm |
Grade D (expert opinion) |
| Croatian Society for Medical Oncology [58] | Croatia | 2017 | NS | Not stated |
| French Dermatology Society and French National Federation of Comprehensive Cancer Centres, French National Cancer Institute [59] | France | 2017 | Margin; 5 mm | All margins; grade B (systematic review of cohort studies, individual cohort study of low quality RCT) |
| Scottish Intercollegiate Guidelines Network [13] | Scotland | 2017 |
Lentigo maligna, (a variant of melanoma in situ), should also be surgically removed, given the risk of invasion. Currently 5 mm surgical margins are recommended Consider a clinical margin of at least 5 mm when excising stage 0 melanoma. If excision for stage 0 melanoma does not achieve an adequate histological margin, discuss further management with the multidisciplinary team |
Level 3 (non-analytic studies, e.g., case series) |
| Swiss guidelines [60] | Switzerland | 2016 | Margin; 5 mm | Not stated |
| Dutch Societies of Radiology, Dermatology and Venereology, Pathology, Surgery, Internal Medicine and Radiology [61] | Netherlands | 2016 | Margin; 5 mm | Level 4, D (case series, poor quality cohort and case–control studies, expert opinion) |
| Central Oncology Institute, Warsaw [62] | Poland | 2016 | Margin; 5 mm | Taken from other guidelines (NCCN, ESMO, EORTC) |
| UK National Disciplinary guidelines for head and neck cancers [63] | UK | 2016 | Margin; 5 mm | Not stated |
| Brazilian Dermatological Society [64] | Brazil | 2015 | Margin; 5 mm | Level A (individual RCT with narrow confidence intervals) |
| National Collaborating Centre for Cancer [65] | UK | 2015 | Margin; 5 mm (stage 0, not specifically in situ) | No evidence, clinical experience |
| State expert Centre of Ministry of Health of Ukraine, National Cancer Institute of the Ministry of Health of Ukraine [12] | Ukraine | 2014 | Margins; 5 mm to ensure complete histological protrusion | Level 3 (systematic review of case–control studies, individual case–control study) |
| German Dermatologic Society and Dermatologic Cooperative Oncology Group [66] | Germany | 2013 | Margin; 5 mm | Grade D (expert consensus) |
| Melanoma cancer site team [67] | Canada | 2013 | Margin; 5–10 mm | Not stated |
| British Association of Dermatologists [68] | UK | 2010 | Margin; 5 mm to achieve complete histological excision | III [evidence obtained from well-designed nonexperimental descriptive studies, such as comparative studies, correlation studies and case studies], grade B [there is fair evidence to support the use of the procedure] (no RCT data, no references) |
| Melanoma Advisory Board [69] | South Africa | 2004 | Margin; 5 mm | Not stated |