Surgical margins in cutaneous melanoma (2 cm versus 5 cm for lesions measuring less than 2.1‐mm thick)

作者：David Khayat, Olivier Rixe, Ginette Martin, Claude Soubrane, Martine Banzet, Jacques‐André Bazex, Philippe Lauret, OLIVIER VEROLA, Gérard Auclerc, Peter Harper, Pierre Banzet · 发表于：Cancer · 年份：2003 · DOI：10.1002/cncr.11272 · 被引用次数：278 · 研究领域：Cutaneous Melanoma Detection and Management、Melanoma and MAPK Pathways、Nonmelanoma Skin Cancer Studies

BACKGROUND: This study addressed the question of whether limited surgery for primary malignant melanoma with a 2-cm margin is as good as a 5-cm margin. An update of a 16-year follow-up is provided. METHODS: Nine European Centers, over a period of 5 years, prospectively randomized 337 patients with melanoma measuring less than 2.1 mm in thickness to undergo a local excision with either a 2-cm or a 5-cm margin. Three hundred twenty-six patients were eligible for statistical analysis. Excluded from the trial were patients older than 70 years; those with melanomas from the toe, nail, or finger; and those with acral-lentiginous melanoma. A separate randomization was performed to independently test an adjuvant treatment with a nonspecific immunostimulant, isoprinosine, compared with observation. The median follow-up time was 192 months (16 years) for the estimation of survival and disease recurrences. RESULTS: There were 22 tumor recurrences in the 2-cm arm and 33 in the 5-cm arm. The median time to disease recurrence was 43 months and 37.6 months, respectively. The 10-year disease-free survival rates were 85% for the group with a 2-cm margin and 83% for the group with a 5-cm margin. There was no difference in the 10-year overall survival rates (87% vs. 86%). Isoprinosine did not demonstrate any activity in this setting. CONCLUSIONS: The authors concluded that for melanoma less than 2.1-mm thick, a margin of excision of 2 cm is sufficient. A larger margin of 5 cm does not appear to...