Surgical Margins in Cutaneous Melanoma: Summary of the Six Major Randomized Trials

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • WHO Melanoma Trial No. 10 (1988):
    • Citation:
      • WHO Melanoma Programme. Lancet. 1988
    • Population:
      • 612 patients with melanomas ≤ 2 mm
    • Arms:
      • 1 cm vs 3 cm surgical excision margins
    • Results:
      • No significant difference in:
        • Local recurrence (LR):
          • ~ 2.3% (1 cm) vs ~2.2 % (3 cm)
        • Overall survival (OS):
          • Similar in both groups
        • Complication rates:
          • Similar
    • Conclusion:
      • 1 cm margins are safe and adequate for melanomas ≤ 1 mm in thickness
      • Wider excisions did not improve outcomes
  • Swedish Melanoma Study Group Trial (1996):
    • Citation:
      • Ringborg U, et al. Cancer. 1996.
    • Population:
      • 989 patients with melanomas 0.8 to 2.0 mm
        • Arms:
      • 2 cm vs 5 cm margins
      • Results:
        • No significant difference in:
          • LR:
            • 3.8% (2 cm) vs 3.6% (5 cm)
          • OS:
            • 65% (2 cm) vs 68% (5 cm) at 10 years
        • Higher rates of skin grafting and wound complications in the 5 cm group
      • Conclusion:
        • 2 cm margins are sufficient
        • 5 cm excision is excessive, with no survival benefit but increased morbidity
  • UK Melanoma Study Group Trial (2004):
    • Citation:
      • Thomas JM, et al. Lancet. 2004.
    • Population:
      • 900 patients with melanomas > 2 mm
    • Arms:
      • 1 cm vs 3 cm margins
    • Results:
      • Local recurrence:
        • 4.6% (1 cm) vs 1.2% (3 cm), p < 0.01
      • 5-year melanoma-specific survival:
        • 65% (1 cm) vs 69% (3 cm), not statistically significant
      • More wound closure problems and skin grafts in the 3 cm group
    • Conclusion:
      • 1 cm margins are inadequate for thick melanomas (> 2 mm)
      • 3 cm margins reduce local recurrence, but without a survival benefit
  • French Cooperative Group Trial (2002, updated 2007):
    • Citation:
      • Veronesi U, et al. NEJM. 2002; Gallardo A, et al. J Clin Oncol. 2007.
    • Population:
      • 742 patients with melanomas > 2 mm
    • Arms:
      • 2 cm vs 5 cm margins
    • Results:
      • LR:
        • 3.7% (2 cm) vs 3.3% (5 cm)
      • Melanoma-specific survival at 10 years:
        • 67% (2 cm) vs 65% (5 cm)
      • Skin grafting more frequent in the 5 cm group
    • Conclusion:
      • 2 cm margins are equivalent to 5 cm margins for thick melanomas
      • 5 cm offers no additional benefit but increases morbidity
  • Intergroup Melanoma Surgical Trial (US, 2001):
    • Citation:
      • Balch CM, et al. Ann Surg Oncol. 2001
    • Population:
      • 740 patients with melanomas 1 to 4 mm thick
      • Arms:
        • 2 cm vs 4 cm margins
      • Results:
        • LR:
          • 1.3% (2 cm) vs 0.9% (4 cm), not significant
        • DFS and OS:
          • No significant difference
        • More skin grafting and delayed healing in the 4 cm group
    • Conclusion:
      • 2 cm margins are sufficient for melanomas 1 to 4 mm in thickness
      • 4 cm margins do not improve outcomes and increase surgical morbidity
  • MelMarT Pilot Trial (2016; Full Results Pending)
    • Citation:
      • Haydu L, et al. Ann Surg. 2016
    • Population:
      • 400 patients with melanomas > 1 mm (pilot phase)
      • Arms:
        • 1 cm vs 2 cm margins
      • Results (pilot):
        • LR, DFS, OS not significantly different (short follow-up)
      • Fewer complications in the 1 cm group
    • Conclusion (preliminary):
      • The 1 cm margin may be sufficient for select patients with intermediate-thickness melanomas
      • Full results from the larger trial (~2,000 patients) are pending and may influence future guidelines
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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