J. Meirion Thomas, F.R.C.S., Julia Newton-Bishop, F.R.C.P., Roger A'Hern, M.Sc., Gill Coombes, R.G.N., Michael Timmons, F.R.C.S., Judy Evans, F.R.C.S., Martin Cook, F.R.C.Path., Jeffery Theaker, F.R.C.Path., Mary Fallowfield, F.R.C.Path., Trevor O'Neill, F.R.C.S., Wlodek Ruka, M.D., Judith M. Bliss, M.Sc., for the United Kingdom Melanoma Study Group, the British Association of Plastic Surgeons, and the Scottish Cancer Therapy Network
Background Controversy exists concerning the necessary marginof excision for cutaneous melanoma 2 mm or greater in thickness.
Methods We conducted a randomized clinical trial comparing 1-cmand 3-cm margins.
Results Of the 900 patients who were enrolled, 453 were randomlyassigned to undergo surgery with a 1-cm margin of excision and447 with a 3-cm margin of excision; the median follow-up was60 months. A 1-cm margin of excision was associated with a significantlyincreased risk of locoregional recurrence. There were 168 locoregionalrecurrences (as first events) in the group with 1-cm marginsof excision, as compared with 142 in the group with 3-cm margins(hazard ratio, 1.26; 95 percent confidence interval, 1.00 to1.59; P=0.05). There were 128 deaths attributable to melanomain the group with 1-cm margins, as compared with 105 in thegroup with 3-cm margins (hazard ratio, 1.24; 95 percent confidenceinterval, 0.96 to 1.61; P=0.1); overall survival was similarin the two groups (hazard ratio for death, 1.07; 95 percentconfidence interval, 0.85 to 1.36; P=0.6).
Conclusions A 1-cm margin of excision for melanoma with a poorprognosis (as defined by a tumor thickness of at least 2 mm)is associated with a significantly greater risk of regionalrecurrence than is a 3-cm margin, but with a similar overallsurvival rate.
Source Information
From the Royal Marsden Hospital National Health Service Trust, London (J.M.T., R.A.); the Division of Genetic Epidemiology, Cancer Research UK, Clinical Center, Leeds, Yorkshire (J.N.-B.); the Institute of Cancer Research, Sutton, Surrey (G.C., J.M.B.); Bradford Royal Infirmary, Bradford, Yorkshire (M.T.); Nuffield Hospital, Plymouth, Devon (J.E.); Royal Surrey Hospital, Guildford, Surrey (M.C.); Southampton General Hospital, Southampton, Hampshire (J.T.); Broomfield Hospital, Colchester, Essex (M.F.); and Norfolk and Norwich Hospital, Norwich, Norfolk (T.O.) — all in the United Kingdom; and the Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (W.R.).
Address reprint requests to Mr. Thomas at the Royal Marsden NHS Trust, Fulham Rd., London SW3 7JJ, United Kingdom.
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