Wide excision shoud not be considered as standart of care for primary cutaneous melanoma
Abstract
Aim. To assess possible influence of surgical margins on local recurrence rate and survival. Methods. Retrospective analysis of the individual data of 352 patients with primary cutaneous melanoma of the trunk and limbs was performed. 108 patients underwent so-called «wide excision» of the tumor with the average margins from the visible tumor edges of 3,5 cm. In 244 patients more «narrow» excision was performed with average margins 2,0 cm. Results and conclusion. Margins had not any influence on treatment results. The frequency of local recurrence, regional and distant metastases, as well as 5-year survival rates were similar in both groups.
About the Authors
L. V. Demidov
FGBU N.N. Blokhin Russian Cancer Research Center
Russian Federation
Russian Federation
K. A. Baryshnikov
FGBU N.N. Blokhin Russian Cancer Research Center
Russian Federation
Russian Federation
E. V. Martynova
Regional oncologic dispensary, Samara
Russian Federation
Russian Federation
I. V. Samoylenko
FGBU N.N. Blokhin Russian Cancer Research Center
Russian Federation
Russian Federation
T. K. Kharatishvili
FGBU N.N. Blokhin Russian Cancer Research Center
Russian Federation
Russian Federation
S. A. Khatyrev
FGBU N.N. Blokhin Russian Cancer Research Center
Russian Federation
Russian Federation
E. A. Cheremushkin
FGBU N.N. Blokhin Russian Cancer Research Center
Russian Federation
Russian Federation
References
1. Handley W. S. The pathology of melanotic growths in relation to their operative treatment. Lancet. 1907, i: 927-33, 996-1003.
2. Balch C.M., Soong S.J., Smith T. et al. Long-term results of a prospective surgical trial comparing 2 cm vs 4 cm excision margins for 740 patients with 1-4 mm melanomas. Ann. Surg. Oncol. 2001, v. 8, p. 101-108.
3. Демидов Л.В., Мартынова Е.В. Ретроспективная оценка безопасного уменьшения границ резекции для меланомы кожи туловища и конечностей 11А стадии. Вопросы онкологии. 2002, т. 48, № 1.
4. Демидов Л.В., Мартынова Е.В. Сравнительная оценка эффективности экономного и широкого иссечений при первичной меланоме кожи туловища и конечностей 11В стадии. Вестник РОНЦ РАМН. 2001, с. 47-53.
5. Барчук А.С., Демидов Л.В. К вопросу о хирургическом лечении поверхностных форм меланомы кожи (статья). Вопросы онкологии. 1998, № 2, т. 44, с. 149-154.
6. Cohn-Cedermark G., Rutqvist L.E., Andersson R. et al. Long term results of a randomized study by the Swedish Melanoma Study Group on 2-cm versus 5-cm resection margins for patients with cutaneous melanoma with a tumor thickness of 0,8-2,0 mm. Cancer. 2000, v. 89, p. 1495-1501.
7. Veronesi U., Cascinelli N., Adamus J. et al. Thin stage I primary cutaneous malignant melanoma: comparison of excision with margins of 1 or 3 cm. N. Engl. J. Med. 1988, v. 318, p. 1159-1162.
8. Breslow A. Prognosis in cutaneous melanoma: tumor thickness as a guide to treatment. Pathol. Annu. 1980, v. 15, p. 1-22.
9. Balch C.M., Soong S.J., Gershenwald J.E. et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J. Clin. Oncol. 2001, v. 19, p. 3622-3634.
10. Balch C.M., Buzaid A.C., Soong S.J. et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J. Clin. Oncol. 2001, v. 19, p. 3635-3648.
11. Malignant tumors (melanomas and related lesions). In: Elder D.E., Murphy G.F. Melanocytic tumors of the skin. Atlas of tumor pathology. 3rd series. Fascicle 2. Washington, D.C.: Armed Forces Institute of Pathology. 1991, p. 103-205.
12. Clark W.H. Jr., From L., Bernardino E.A., Mihm M.C. The histogenesis and biologic behavior of primary human malignant melanomas of the skin. Cancer Res. 1969, v. 29 (3), p. 705-727.
13. Kaufmann R. Surgical management of primary melanoma. Clin. Exp. Dermatol. 2000, v. 25, p. 476-481.
14. Kroon B.B., Nieweg O.E. Management of malignant melanoma. Ann. Chir. Gynaecol. 2000, v. 89, p. 242-250.
15. Bishop J.A., Corrie P.G., Evans J. et al. UK guidelines for the management of cutaneous melanoma. Br. J. Plast. Surg. 2002, v. 55, p. 46-54.
16. Veronesi U., Cascinelli N. Narrow excision (1-cm margin). A safe procedure for thin cutaneous melanoma. Arch. Surg. 1991, v. 126 (4), p. 438-441. World Health Organization Melanoma Programme, National Tumor Institute, Milan, Italy.
17. Thomas J.M., Newton-Bishop J., A’Hern R., Coombes G. et al. Excision margins in high-risk malignant melanoma. N. Engl. J. Med. 2004; 19; v. 350 (8), p. 757-766.
18. Kroon B.B., Bergman W., Coebergh J.W., Ruiter D.J. Consensus on the management of malignant melanoma of the skin in the Netherlands. Melanoma Res. 1999, v. 9, p. 207-212.
19. The management of cutaneous melanoma. Clinical practice guidelines. Canberra, Australia: National Health and Medical Research Council, 1999. (Accessed January 27, 2004, at http://www.health.gov.au/nhmrc/publications/synopses/ cp68syn.htm.)
20. Travis E., Gotz M.D., Jaime M. et al. Preservation of the deep muscular fascia and locoregional control in melanoma. Surgery, 4 Dec 2012. J. surg. 2012.09.009. Epub. ahead of print.
Review
For citations:
Demidov L.V., Baryshnikov K.A., Martynova E.V., Samoylenko I.V., Kharatishvili T.K., Khatyrev S.A., Cheremushkin E.A. Wide excision shoud not be considered as standart of care for primary cutaneous melanoma. Bone and soft tissue sarcomas, tumors of the skin. 2013;(1):54-59. (In Russ.)
Views:
74
Email this article 
