A policy of selective excision for primary cutaneous malignant melanoma.

A policy of selective conservative excision of cutaneous malignant melanoma based upon clinical assessment of tumour type has been studied prospectively in 163 patients treated over a 10-year period. Melanomas have been divided into three groups after clinical assessment--impalpable, palpable but not nodular, and overtly nodular--and excised with 1, 2 and 3-5 cm margins respectively. These clinical groups have been shown to correspond broadly to thickness ranges of less than or equal to 0.75 mm, 0.76-1.49 mm and greater than or equal to 1.50 mm respectively. Two to 12-year follow-up has shown no adverse effect on outcome in terms of both local and regional recurrence. One in four patients had a 1 cm clearance, and 67.5% of patients were saved a conventional 5 cm clearance with its cosmetic and functional consequences. The width of excision for melanoma can confidently be reduced on a selective basis to the levels used in this study. Additional prospective studies are required before any further reduction can be recommended.