AI Article Synopsis
- The study investigates the impact of excision margin size on the recurrence and survival rates in patients with cutaneous melanoma thicker than 2 mm.
- Patients were randomly assigned to receive either a 1-cm or a 3-cm surgical margin, with follow-up averaging 60 months.
- Results showed a significantly higher rate of locoregional recurrences in the 1-cm group compared to the 3-cm group, indicating that a wider margin may reduce recurrence risk without affecting overall survival rates.
Article Abstract
Background: Controversy exists concerning the necessary margin of excision for cutaneous melanoma 2 mm or greater in thickness.
Methods: We conducted a randomized clinical trial comparing 1-cm and 3-cm margins.
Results: Of the 900 patients who were enrolled, 453 were randomly assigned to undergo surgery with a 1-cm margin of excision and 447 with a 3-cm margin of excision; the median follow-up was 60 months. A 1-cm margin of excision was associated with a significantly increased risk of locoregional recurrence. There were 168 locoregional recurrences (as first events) in the group with 1-cm margins of excision, as compared with 142 in the group with 3-cm margins (hazard ratio, 1.26; 95 percent confidence interval, 1.00 to 1.59; P=0.05). There were 128 deaths attributable to melanoma in the group with 1-cm margins, as compared with 105 in the group with 3-cm margins (hazard ratio, 1.24; 95 percent confidence interval, 0.96 to 1.61; P=0.1); overall survival was similar in the two groups (hazard ratio for death, 1.07; 95 percent confidence interval, 0.85 to 1.36; P=0.6).
Conclusions: A 1-cm margin of excision for melanoma with a poor prognosis (as defined by a tumor thickness of at least 2 mm) is associated with a significantly greater risk of regional recurrence than is a 3-cm margin, but with a similar overall survival rate.
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| http://dx.doi.org/10.1056/NEJMoa030681 | DOI Listing |
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