Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1 to 4 mm): Results of a multi-institutional randomized surgical trial

C. M. Balch, M. M. Urist, C. P. Karakousis, T. J. Smith, W. J. Temple, K. Drzewiecki, W. R. Jewell, A. A. Bartolucci, M. C. Mihm, R. Barnhill, H. J. Wanebo

Research output: Contribution to journalArticle

Abstract

Background: A prospective, multi-institutional randomized surgical trial involving 486 localized melanoma patients was conducted to determine whether excision margins for intermediate-thickness melanomas (1.0 to 4.0 mm) could be safely reduced from the standard 4-cm radius. Methods: Patients with 1- to 4-mm-thick melanomas on the trunk or proximal extremities were randomly assigned to receive either a 2- or 4-cm surgical margin. Results: The median follow-up time was 6 years. The local recurrence rate was 0.8% for 2-cm margins and 1.7% for 4-cm margins (p value not significant [NS]). The rates of in-transit metastases were 2.1% and 2.5%, respectively (p = NS). Of the six patients with local recurrences, five have died. Recurrence rates did not correlate with surgical margins, even among stratified thickness groups. The overall 5-year survival rate was 79.5% for the 2-cm margin patients and 83.7% for the 4-cm margin patients (p = NS). The need for skin grafting was reduced from 46% with 4-cm surgical margins to 11% with 2-cm surgical margins (p < 0.001). The hospital stay was shortened from 7.0 days for patients receiving 4-cm surgical margins to 5.2 days for those receiving 2-cm margins (p = 0.0001). This reduction was largely due to reduced need for skin grafting, since the hospital stay for those who had a skin graft was 2.5 days longer than that for those who had a primary wound closure (p < 0.01). Conclusion: Margins of excision can be safely reduced to 2 cm for patients with intermediate-thickness melanomas. The narrower margins significantly reduced the need for skin grafting and shortened the hospital stay.

Original languageEnglish (US)
Pages (from-to)262-269
Number of pages8
JournalAnnals of surgery
Volume218
Issue number3
DOIs
StatePublished - 1993

ASJC Scopus subject areas

  • Surgery

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    Balch, C. M., Urist, M. M., Karakousis, C. P., Smith, T. J., Temple, W. J., Drzewiecki, K., Jewell, W. R., Bartolucci, A. A., Mihm, M. C., Barnhill, R., & Wanebo, H. J. (1993). Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1 to 4 mm): Results of a multi-institutional randomized surgical trial. Annals of surgery, 218(3), 262-269. https://doi.org/10.1097/00000658-199309000-00005