Background: Melanoma guidelines recommend surgical excision with 2-cm margins for melanomas >2 mm in thickness. However, this procedure may be problematic at critical anatomic sites. We aimed to compare the outcomes of wide (2 cm) versus narrow (1 cm) excision margins in patients with melanoma >2 mm in thickness near critical structures. Patients and Methods: We retrospectively examined 736 patients undergoing excision with wide versus narrow margins at the National Cancer Institute in Milan, Italy, between 2001 and 2015. Results: A total of 265 (36.0%) patients received a wide local excision—82 (30.9%) with linear repair and 183 (69.1%) with flap or graft reconstruction. A total of 471 (64.0%) patients received a narrow excision—320 (67.9%) with linear repair and 151 (32.1%) with flap or graft reconstruction (P<.001). The 10-year overall survival rate was 69.5% (95% CI, 63.3%–76.2%) in the wide group and 68.7% (95% CI, 63.8%–74.0%) in the narrow group (P=.462); 10-year crude cumulative incidence (CCI) of local recurrence was 5.4% (95% CI, 3.2%–9.2%) in the wide and 8.8% (95% CI, 6.4%–12.1%) in the narrow group (P=.150). Multivariable Fine-Gray modeling of the CCI of local recurrence showed that Breslow thickness (P=.010) was the only statistically significant parameter. Multivariable Cox models for overall survival showed that age (P<.001), Breslow thickness (P<.001), and sentinel lymph node status (P=.019) were statistically significant covariates. Excision margin was not a significant parameter affecting patients’ outcome. Conclusions: Wide local excision with 1-cm margins for melanoma >2 mm in thickness was not associated with an increased risk of local recurrence and did not affect overall survival.
Submitted September 4, 2023; final revision received May 12, 2024; accepted for publication July 8, 2024. Published online November 13, 2024.
A. Maurichi and F. Barretta contributed equally as co–first authors.
R. Miceli and M. Santinami contributed equally as co–last authors.
Author contributions: Concept & design, and/or acquisition of data, and/or data analysis & interpretation: Maurichi, Barretta, Patuzzo, Shimonovitz-Moore, Nizri, Cortinovis, Miceli, Santinami. Writing—original draft: Maurichi, Barretta, Gallino, Mattavelli, Matteucci, Summo, Cossa, Valeri, Miceli, Santinami. Writing—review & editing: Maurichi, Barretta, Gallino, Mattavelli, Matteucci, Summo, Cossa, Valeri, Miceli, Santinami. Final approval: All authors.
Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: The Emme Rouge Foundation provided financial support for this study.