Clinical Trial Evaluates Smaller Surgical Margins for Stage 2 Melanoma Patients

Source: Roswell Park, June 2023

Although most primary cutaneous melanomas are treated with surgical excision alone, current international guidelines vary on the optimal size for the surgical margins, which can range from 1 to 3 cm. based on Breslow thickness. In the short term, wider excisions may be associated with greater risk of complications. Over the long term, they can be associated with neuropathic pain and poor cosmesis, often requiring reconstructive surgery — side effects that can diminish quality of life. That’s a significant concern for the majority of patients with stage 2 melanoma, who typically survive more than 10 years after diagnosis.

“Initially melanomas were treated with huge excisions — five centimeters in every direction,” says Shalana O’Brien, MD, Department of Surgical Oncology at Roswell Park Comprehensive Cancer Center. “But since the early ’90s, margins have been decreasing for melanoma, based on multiple trials.

“Currently in the U.S., for thin melanomas — less than one millimeter in depth — we take one-centimeter margins,” she explains. “For those between one and two millimeters in thickness, we take either one- or two-centimeter margins, and anything greater than two millimeters in thickness, we take a two-centimeter margin. These guidelines vary slightly throughout the world.”