The ideal surgical excision margin for patients with thick (>2 mm) localized cutaneous melanomas is unclear, where the risk of recurrence must be weighed against excess morbidity resulting from larger skin defects with wide excision. In this randomized controlled trial, 936 clinically staged patients were recruited and randomly assigned to a 4-cm (n=465) or 2-cm excision margin (n=471) and followed up for a median of 19.6 years to compare melanoma-specific and overall survival. Researchers found that the overall death rate was highest during the first 5 years of follow-up, and comparable between groups. Over the course of the follow-up period 621 deaths were reported, where there were 304 deaths (49%) in the 2-cm group and 317 deaths (51%) in the 4-cm group (HR 0.98, 95% CI 0.83 to 1.14, p=0.75). Of these deaths, 397 were attributed to cutaneous melanoma, with 192 deaths (48%) occurring in the 2-cm excision margin group and 205 deaths (52%) in the 4-cm excision margin group (HR 0.95, 95% CI 0.78 to 1.16, p=0.61). This study therefore shows that a 2-cm excision margin in patients with thick, localized cutaneous melanoma confers similar melanoma-specific and overall survival when compared to a more extensive 4-cm excision margin. This has important implications in mitigating the morbidity associated with surgical management of melanoma.
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