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Soo Park, MD
Soo Park, MD
Posted: Friday, January 24, 2025
For patients with primary cutaneous melanomas greater than 2 mm in thickness, wide local excision with 1-cm margins may be a suitable and effective management strategy to reduce the number of reconstructive surgeries, according to a study published in JNCCN–Journal of the National Comprehensive Cancer Network. This study outlines the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and suggests this treatment approach may be employed in other anatomic sites as well, explained Mario Santinami, MD, of Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy, and colleagues.
From 2001 to 2015, a total of 736 patients with primary cutaneous melanoma were recruited for the study. Demographic data were collected on all patients. Patients were stratified based on the final margins of their surgical excisions. The 1-cm margins were characterized as a narrow local excision (n = 471), and 2-cm margins were classified as a wide local excision (n = 265). Patients subsequently underwent sentinel lymph node biopsies, and complete lymph node dissections were performed in patients with positive lymph nodes.
The study authors reported a comparable 10-year overall survival in patients who received either a narrow local excision (68.7%) or a wide local excision (69.5%). No significant differences were identified in the crude cumulative incidence (8.8% for narrow vs 5.4% for wide). In addition, the only significant parameter to impact the crude cumulative incidence was Breslow thickness. Furthermore, age, sentinel lymph node status, and Breslow thickness were the only significant variables that seemed to impact overall survival.
Safety was the secondary aim of this study. The investigators reported that fewer patients in the narrow group required reconstructive surgery than those in the wide group (32.1% vs 69.1%). “This difference was significant (P < .001) and suggests that narrower margins can reduce infection, poor healing, scarring, and mental issues often occurring with excisions close to critical structures,” they added.
Disclosure: For the full disclosures of the study authors, visit jnccn.org.
JNCCN–Journal of the National Comprehensive Cancer Network
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