patients who had undergone narrower margin excision for tumours of varying Breslow thickness.34–40 These studies suggested that margins narrower than 4-5cm could be taken without increasing the risk of local recurrence. However, they also demonstrated an increased rate of local recurrence when very narrow (<0.5cm) margins were taken. Prospective randomised studies were therefore required and to date there have been six published trials.41–46 The details of the published randomised trials are documented in Table 1.1.2. Table 1.1.2. Completed randomized trials comparing excision margins for melanoma. Study Period Excision Number of Primary Primary Overall of margins patients melanoma survival compared sites thickness and/or n Fat inclusion subtypes n criteria excluded World Health 1cm 1-2cm 703 ≤2mm At 8yrs Organization 1985 vs wider 89.6% 3cm than skin (1cm) vs excision 90.3% (3cm), p =0.64 French 2cm 337 <2mm, Toe, nail, At 10yrs operative vs down age <70 finger 87% (2cm) Group44 5cm to lesions, vs 85% muscle (5cm), fascia arising p=0.56 form melanosis, lentigo and acral lesions. Intergroup Not 2cm Same as 486* 1 to 4 mm Lentigo At 10 yrs Melanoma stated vs 4 skin 470* maligna 70% (2cm) Trial42,49 cm down to 468* melanoma, vs 77% or (4cm), including distal to p=0.07 fascia knee or elbow or on head and neck Swedish 2cm Incisions 989 >0.8 to Head and At 10 yrs Melanoma vs 5 extended 2mm neck, 79% (2cm) Study cm to or hands, feet. vs 76% Group43,50 included (5cm), fascia UK Melanoma 1cm Not 900 ≥2mm Head and No Study Group45 2001 vs stated neck, significant
patients who had undergone narrower margin excision for tumours of varying Breslow thickness.34–40 These studies suggested that margins narrower than 4-5cm could be taken without increasing the risk of local recurrence. However, they also demonstrated an increased rate of local recurrence when very narrow (<0.5cm) margins were taken. Prospective randomised studies were therefore required and to date there have been six published trials.41–46 The details of the published randomised trials are documented in Table 1.1.2. Table 1.1.2. Completed randomized trials comparing excision margins for melanoma. Study Period of Excision margins compared Number of patients Primary thickness inclusion criteria Primary melanoma sites and/or subtypes excluded Overall survival Fat World Health Organization 1cm vs 3cm 1-2cm wider than skin excision 703 ≤2mm At 8yrs 89.6% (1cm) vs 90.3% (3cm), p =0.64 French Group44 2cm vs 5cm down to muscle fascia 337 <2mm, age <70 Toe, nail, finger lesions, arising form melanosis, lentigo and acral lesions. At 10yrs 87% (2cm) vs 85% (5cm), p=0.56 Intergroup Melanoma Trial42,49 Not stated 2cm vs 4 cm Same as skin down to or including fascia 486* 470* 468* 1 to 4 mm Lentigo maligna melanoma, distal to knee or elbow or on head and neck At 10 yrs 70% (2cm) vs 77% (4cm), p=0.07 Swedish Melanoma Study Group43,50 2cm vs 5 cm Incisions extended to or included fascia 989 >0.8 to 2mm Head and neck, hands, feet. At 10 yrs 79% (2cm) vs 76% (5cm), UK Melanoma Study Group45 1cm vs Not stated 900 ≥2mm Head and neck, No significant operative 2001 n n 1985