Melanoma of the Face: The Safety of Narrow Excision Margins

Abstract

Recent studies have shown that narrower excision margins may be safe, but the optimal or minimum margin for melanoma is unknown. Wide margins of excision are possible on the trunk and limbs, but functional and cosmetic constraints often limit the extent of excision on the face. A collaborative study from two continents (Cape Town, South Africa and Northwood, England) investigated the outcome of different excision margins of 106 patients with stage I melanoma of the face. The margin of excision was measured from the records of the pathological specimen. Thirty patients had margins of less than 1 cm, 64 had margins of between 1 and 2 cm, and 12 had margins greater than 2 cm. Primary apposition or flap closure was possible in 85 patients. Seven patients developed local recurrences and these were not influenced by the excision margin. This study supports the contention that the primary treatment of cutaneous melanoma on the face should be histologically confirmed complete excision, and that this can be achieved with margins of excision less than 1 cm. Local recurrence is not related to the margin of excision or to tumour thickness.

Adherence to guideline excision margins in head and neck melanoma: the influence on 5-year survival and loco-regional recurrence

“…Quoted 5-year survival figures for head and neck melanoma include 65%, 70%, 77%, 82%, 85% and 85% [5,7,10,23,[26][27][28], and quoted loco-regional recurrence rates include 12%, 15%, 19%, 20%, 23% and 27% [2,4,5,26,28,29]. Direct comparison between different studies however is hindered by variations in Breslow thickness for the different cohort populations [6,7,21,23,26,28,29]. Despite this, our figures would indicate that management of this disease remains sub-optimal, and this emphasises the need to optimise its management.…”

“…compared to margins ranging from 11 to 70 mm (83% 5.y.s.). Similarly, Hudson et al [28] failed to account for tumour depth when they reported that, in 106 cases of clinical stage 1 facial melanoma, categorisation by excision margin (<1, 1-2 and >2 cm) failed to show statistically significant differences in long-term recurrence or survival (local recurrence, <1 cm 13%, 1-2 cm 14%, >2 cm 12%; melanoma-specific survival, <1 cm 92%, 1-2 cm 80%, >2 cm 66%). Thus, the results from both studies are difficult to apply clinically.…”

“…Of the three available head and neck specific studies which examine the effect of surgical margins on recurrence and survival [23,28,29], only that by Andersson et al [29] provides clinically useful information. They divided 420 patients with clinical stage 1 head and neck melanoma into those who had had margins of excision <2 cm and ≥2 cm and subdivided these by Breslow thickness grouping (<1, 1.0-1.99 and ≥2 mm).…”

Principles of evidence‐based management using stage I–II melanoma as a model

“…This Level 1 evidence supports the recommendation that MIS can be removed with a 5‐mm margin. Four other studies involving MIS also presented convincing evidence that a 1‐cm margin or less is adequate 11–16 …”

“…Some evidence clearly indicates a surgical excision with a 1-cm margin is not much different from a 2-cm margin. [6][7][8][9][10][11][12][13][14][15][16] There are differing opinions concerning the excisional margins for melanoma in situ (MIS). Some authors advocate a minimum of 1-2 cm margin for MIS.…”