Excision margins in the treatment of primary cutaneous melanoma: a systematic review of randomized controlled trials comparing narrow vs wide excision.

BACKGROUND

The optimal excision margin for primary cutaneous melanoma remains controversial, although several clinical studies have suggested that wide local excision is unnecessary.

HYPOTHESIS

Wide excision margins do not improve survival in patients with melanoma.

OBJECTIVES

To describe the published evidence and determine the effectiveness of wide surgical margins compared with narrow surgical margins.

DESIGN

Systematic review of randomized controlled trials that compared narrow margins with wide excision margins for cutaneous melanoma.

SETTING

Randomized controlled trials available by March 2001.

SUBJECTS

The included trials comprised 2406 participants.

INTERVENTION

Surgical excision of melanoma using narrow excision margins compared with excision using wide excision margins.

MAIN OUTCOME MEASURE

Effect of width of excision margin on melanoma recurrences, disease-free survival, and overall survival.

RESULTS

We identified and analyzed 4 randomized controlled trials. All 4 trials failed to demonstrate statistically significant differences in overall survival and disease-free survival when comparing wide vs narrow excision. Peto pooled odds ratio for overall survival was 0.79 (95% confidence interval, 0.61-1.04) and for disease-free survival was 0.89 (95% confidence interval, 0.69-1.13), indicating a statistically nonsignificant improvement with wide excision.

CONCLUSIONS

Not one of the included studies showed any statistically significant difference between the 2 groups treated with narrow or wide excision margins with regard to recurrences and survival. However, current evidence is not sufficient to address the optimal surgical margins for all melanomas, and further research is required.