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No difference in survival with smaller melanoma excision margin

A 2cm excision margin on skin melanomas thicker than 2mm is as safe as a 4cm margin, finds a European study.

Researchers conducted a randomised controlled trial between 1992 and 2004, with some of the patients followed up until 2011. Some 936 patients from Sweden, Norway, Denmark and Estonia had a skin melanoma thicker than 2mm, at clinical stage IIA-C, with 465 allocated to have the melanoma excised with a 2cm margin, and 471 allocated to a 4cm margin.

Five-year overall survival was 65%, and recurrence at five years 44%, in both groups.  After median follow-up of 6.7 years, 39% of patients in the 2cm group and 38% in the 4cm group had died.

The researchers said there was a need to strike a balance in removing a melanoma between relapse risk with a narrow excision and the possible complications of a wide excision, such as poor cosmetic results, longer hospital stay and need for skin grafts.

Study leader Dr Peter Gillgren, surgeon at Stockholm Sodersjukhuset said: ‘Our study is the largest randomised controlled trial of resection margins for thick melanomas. Overall survival was equal in the two groups.'

Lancet 2011, published online 24 October

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