Stekelenburg Iza, Laeijendecker Annelien E, van Doorn Ruth C, Doeksen Annemiek, Blokx Willeke A M, Schrage Yvonne M, van Akkooi Alexander C J, Scolyer Richard A, Postma Emily L, Sharouni Mary Ann El
Department of Surgical Oncology, St. Antonius Hospital, Utrecht, Nieuwegein, Netherlands.
Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Eur J Cancer. 2025 May 2;220:115366. doi: 10.1016/j.ejca.2025.115366. Epub 2025 Apr 1.
This study examines whether wide local excision (WLE) after complete diagnostic excision improves recurrence-free survival (RFS) in clinical stage I/II primary cutaneous melanoma.
Since the 1950s, melanoma treatment has included a two-step surgical approach, involving diagnostic excision followed by WLE. WLE aims to achieve locoregional disease control by eliminating potential microsatellites and, thus, minimising the risk of locoregional recurrence and melanoma-related death. However, its impact on RFS is unclear, while it adds morbidity and costs.
This retrospective nationwide cohort study analysed pathology reports of a Dutch population-based cohort of newly diagnosed invasive cutaneous melanoma patients who underwent a complete diagnostic excision between January 1st, 2012, and December 31st, 2013. Data were obtained from the Dutch Nationwide Pathology Database (PALGA). Patients with completely excised superficial spreading and nodular melanoma located on the trunk and upper and lower extremities were included. Cox regression showed no significant RFS benefit from WLE.
A total of 6189 eligible patients were included. WLE was not performed in 271 patients (4.4 %). Of those undergoing WLE (n = 5918), residual dermal invasive tumour cells were identified in 0.7 % (n = 44/5918). The overall recurrence rate was 7.7 % (n = 477/6189). Recurrence rates were 7.6 % for WLE cases (local: 2.5 %, nodal: 4.0 %, distant: 1.2 %) and 10.3 % when WLE was omitted. Cox regression showed no significant RFS benefit from WLE.
WLE does not significantly improve RFS in patients with completely excised cutaneous superficial spreading and nodular melanoma on the trunk or extremities.
本研究旨在探讨在完整诊断性切除术后进行广泛局部切除（WLE）是否能提高临床I/II期原发性皮肤黑色素瘤患者的无复发生存率（RFS）。
自20世纪50年代以来，黑色素瘤的治疗采用两步手术方法，包括诊断性切除，随后进行WLE。WLE旨在通过消除潜在的微卫星灶来实现局部区域疾病控制，从而将局部区域复发和黑色素瘤相关死亡的风险降至最低。然而，其对RFS的影响尚不清楚，同时还会增加发病率和成本。
这项全国性回顾性队列研究分析了2012年1月1日至2013年12月31日期间在荷兰进行了完整诊断性切除的新诊断浸润性皮肤黑色素瘤患者的病理报告。数据来自荷兰全国病理数据库（PALGA）。纳入了躯干、上肢和下肢完全切除的浅表扩散型和结节型黑色素瘤患者。Cox回归分析显示，WLE对RFS无显著益处。
共纳入6189例符合条件的患者。271例患者（4.4%）未进行WLE。在进行WLE的患者中（n = 5918），0.7%（n = 44/5918）发现残留真皮浸润性肿瘤细胞。总体复发率为7.7%（n = 477/6189）。WLE病例的复发率为7.6%（局部：2.5%，区域淋巴结：4.0%，远处：1.2%），未进行WLE时复发率为10.3%。Cox回归分析显示，WLE对RFS无显著益处。
对于躯干或四肢完全切除的皮肤浅表扩散型和结节型黑色素瘤患者，WLE并不能显著提高RFS。
