The surgical treatment of primary cutaneous malignant melanoma has been an issue of debate throughout the past decades. It is generally accepted that the excised tumor-free surgical margins around the lesion should be proportional to the lesion thickness. However, the issue of adequate thickness of tumor-free margins to be resected in the depth of the lesion has not been addressed as yet. In order to assess the influence of thickness of the tumor-free margins resected under malignant melanoma on patients outcome, we have reviewed 48 patients treated for primary cutaneous malignant melanoma in the Rabin Medical Center in the years 1987–1988. Biopsy specimens and clinical charts were evaluated, the tumor-free margin in depth of the excision was measured and compared with clinical outcome. The study population comprised 21 men and 27 women with an average age of 60.2±15.2 years. Most of the primary melanomas were of intermediate thickness with a mean Breslow thickness of 1.6 mm. During a median follow-up time of 112.8 months, ten (21%) patients developed relapse of their malignancy and 13 patients (27.08%) died. In univariate analysis, the thickness of the tumor-free margin excised under the melanoma was one of seven clinical and pathological variables that showed significant predictive value for patient survival. The 10-year survival rate in patients with tumor-free margins thinner than 3 mm was 50%, compared with 82% in patients with thicker tumor-free margins (P=0.01). In multivariate analysis, these margins remained an independent significant prognostic factor, as were four other variables. Evidence indicating a tendency for local and distant melanoma recurrence in thin excisions with small margin/tumor thickness ratio was detected. The recurrence rate in the group with margin/tumor thickness ratio smaller than 1 was nearly five times higher than the rate in patients with higher ratios (66% vs 14%, P=0.003). In univariate and multivariate analysis of 10 years survival, this ratio also proved to be an independent prognostic factor. In this study we have shown that the tumor-free margins resected under the lesion play an important role in the comprehensive surgical treatment of primary cutaneous melanoma and in determining the clinical outcome of the patients.
European Journal of Plastic Surgery – Springer Journals
Published: Mar 17, 2001
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