Efficacy

The recommendations for surgical margins are based on three RCTs and have included patients with lesions of Breslow thickness up to 5 mm. The World Health Organization Melanoma Group randomised 612 patients with melanomas less than 2 mm in depth to surgical excision with either 1 cm or 3 cm margins.15 The mean follow up period was 90 months and there was no difference in overall or disease-free survival between the two groups. A US Intergroup Study randomised 486 patients with intermediate thickness lesions (1-4 mm in depth, to either 2 cm or 4 cm margins.16 The median follow up period was 6 years. The local recurrence rate was 0-8% for the 2 cm margin group and 1-7% for the 4 cm group. The overall survival rates over 5 years were 79-5% and 83-7%, respectively. The Swedish Melanoma Study Group randomised 769 patients with lesions of 0-8-2 mm in depth to either 2 cm or 5 cm margins, and have recently reported their long-term results with a median follow up period of 11 years.17 The estimated relative hazard ratios for overall survival and relapse-free survival were

0-96 (95% confidence intervals (CI) 0-75-1-25) and

1-02 (CI 0-8-1-30), respectively. There was no significant difference in local recurrence rates or overall survival between the narrower and wider margins of excision in any of the trials.

A retrospective observational study of 278 patients with thick lesions (median thickness 6 mm) suggested that 2 cm margins were adequate and that wider margins did not improve local recurrence rates, disease-free survival or overall survival rates.18

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