Optimum excision margins for melanoma.

Melanoma Institute Australia, The Poche Centre, North Sydney, NSW 2060, Australia.
The Lancet (Impact Factor: 39.21). 11/2011; 378(9803):1608-10. DOI: 10.1016/S0140-6736(11)61615-2
Source: PubMed
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    ABSTRACT: An accurate and complete pathology report is critical for the optimal management of cutaneous melanoma patients. Protocols for the pathologic reporting of melanoma have been independently developed by the Royal College of Pathologists of Australasia (RCPA), Royal College of Pathologists (United Kingdom) (RCPath), and College of American Pathologists (CAP). In this study, data sets, checklists, and structured reporting protocols for pathologic examination and reporting of cutaneous melanoma were analyzed by an international panel of melanoma pathologists and clinicians with the aim of developing a common, internationally agreed upon, evidence-based data set. The International Collaboration on Cancer Reporting cutaneous melanoma expert review panel analyzed the existing RCPA, RCPath, and CAP data sets to develop a protocol containing "required" (mandatory/core) and "recommended" (nonmandatory/noncore) elements. Required elements were defined as those that had agreed evidentiary support at National Health and Medical Research Council level III-2 level of evidence or above and that were unanimously agreed upon by the review panel to be essential for the clinical management, staging, or assessment of the prognosis of melanoma or fundamental for pathologic diagnosis. Recommended elements were those considered to be clinically important and recommended for good practice but with lesser degrees of supportive evidence. Sixteen core/required data elements for cutaneous melanoma pathology reports were defined (with an additional 4 core/required elements for specimens received with lymph nodes). Eighteen additional data elements with a lesser level of evidentiary support were included in the recommended data set. Consensus response values (permitted responses) were formulated for each data item. Development and agreement of this evidence-based protocol at an international level was accomplished in a timely and efficient manner, and the processes described herein may facilitate the development of protocols for other tumor types. Widespread utilization of an internationally agreed upon, structured pathology data set for melanoma will lead not only to improved patient management but is a prerequisite for research and for international benchmarking in health care.
    The American journal of surgical pathology 09/2013; DOI:10.1097/PAS.0b013e31829d7f35 · 4.59 Impact Factor
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    ABSTRACT: BACKGROUND: NCCN guidelines recommend 1 or 2 cm margins for melanomas 1-2 mm (T2 melanomas) in depth; however, no head-to-head comparison has been performed. We hypothesized 1- or 2-cm margins would have similar local recurrence (LR) and overall survival (OS). METHODS: An institutional database was queried for patients with 1.0-2.0 mm melanomas treated from July 1995 to January 2011. All had wide excision and sentinel lymph node biopsy. Patients without documented surgical margins or follow-up were excluded. Clinicopathologic and recurrence data were reviewed. Univariate and multivariate analyses were performed. RESULTS: Of 2,118 patients, 1,225 met study criteria. Of these, 576 had complete data: 224 (38.9 %) had 1 cm margins and 352 (61.1 %), 2 cm margins. Median follow-up was 38 months. Mean age was 52.6 years (range 11.3-86.7). Mean thickness was 1.27 and 1.48 mm (1 and 2 cm, respectively, p < 0.001) with ulceration more common in the 2 cm group (12.3 and 21.3 %, respectively; p = 0.009). LR was 3.6 and 0.9 % in the 1 cm versus 2 cm group, respectively (p = 0.044). OS was 29.1 months with 1 cm and 43.7 months in the 2 cm group. On multivariate analysis, only head and neck location and nodal status were associated with overall survival. CONCLUSIONS: In this series, 1 cm margins were associated with a small increase in LR that did not impact OS. This is concordant with the NCCN recommendations; however, a prospective, randomized trial would be optimal.
    Annals of Surgical Oncology 08/2012; DOI:10.1245/s10434-012-2543-8 · 3.94 Impact Factor